Cretins, persons in whom partial or complete idiocy is combined with great bodily deformity. The name cretin is of uncertain origin. Virey derives it from chretien, Christian, because the inhabitants of the countries where cretinism prevails were very generally disposed to regard the cretins as incapable of sinfulness ("souls without sin," they call them), and hence regarded them as favored of God, or "good Christians." Blackie derives it from the Romance or Grison cretina, a corruption of the Latin creatura, a creature; corresponding to the term Geschopf, by which they are designated in some parts of Germany. The characteristics of the cretin, as given by Berchtold Beaupie, in his Dissertation sur les cretins, are: a large head, squat and bloated figure, bleared and hollow eyes, projecting eyelids, flat nose, and protruding tongue; the chest is narrow, back curved, limbs short and misshapen, knees thick, feet flat; the belly is loose, like a bag, the integuments being so relaxed that they cannot retain the intestines in its cavity. The cretin can scarcely walk, hear, or speak. He is greedy for food, and has the sexual instinct largely developed, in its most brutal form. This unfortunate class are far more widely distributed than has been generally supposed.
Throughout the whole sub-Alpine region in Europe, as well as in some of the more level regions, they are found in great numbers. The goitre or bronchocele, so prevalent throughout the whole of the Alpine countries, is often accompanied by cretinism, and is, with very few exceptions, always found on the cretin. Switzerland, and especially the cantons Valais, Vaud, Uri, Aar-gau, Grisons, and Glarus, seem to be the home of this frightful deformity. It is endemic in portions of Rhenish Prussia, Baden, Piedmont, Bavaria, Upper Austria, Wurtemberg, Denmark, Norway, in the Alpine departments of France, in portions of Turkey and Russia, and in the highlands of Scotland. In Africa it has been found prevalent along the northern slope of the Atlas range. In Asia, the districts around the base of the Himalaya range furnish great numbers of cases, as well as China, Chinese Tar-tary, and Sumatra. In South America, cretins are found in considerable numbers on the eastern or Atlantic slope of the Andes; and scattered cases occur along the Alleghany, Green mountain, and Hoosac ranges in the United States. In some parts of Canada cases have also been observed. The number of cretins in the sub-Alpine districts of Europe, whether considered actually or relatively to the population, is frightfully large.
In some localities in Switzerland, Rhenish Prussia, and the Alpine districts of France and Savoy, there are whole villages in which not an able-bodied man can be found. - The causes of cretinism are involved in some obscurity, though many of the ablest medical men in Europe have investigated the subject with great care. The localities in which it is most prevalent in the Alpine districts are low-lying valleys, narrow, and exposed to the direct rays of the sun but for a few hours each day, and usually having but one outlet. In these, the air is often stagnant and the heat intense; the water is also in some cases charged with mineral impurities, especially the salts of lime; the food of the inhabitants is often scanty in quantity, and inferior in quality; they are in many cases grossly intemperate, and intermarriage with near relatives, and those affected with goitre or incipient cretinism, is common. In some countries it occurs on open plains, but in other respects under circumstances analogous to those already named. The life of the cretin is usually short; few are found above 30 years of age, and any treatment having in view the improvement of their health must, to be of benefit, be applied to the young. The recovery of a patient beyond the age of 12 years is almost hopeless.
The first thing to be accomplished is the removal of the young cretin, as soon as possible after the disease exhibits itself, to a pure bracing atmosphere. It has been ascertained that on the Alps the disease seldom occurs at an elevation of 3,000 ft. above the level of the sea, and never at the height of 4,000 ft. Hence, those who have attempted its treatment in Europe have preferred elevated locations. The treatment requires an abundance of pure water, for drinking, washing, and bathing; warm and cold baths and douches; friction of the skin with brushes and stimulating liquids, to rouse its action.; warm clothing; gymnastic exercises; mineral tonics; nourishing food; iodine, cod-liver oil, and phosphates. Galvanism and electro-magnetism are also of benefit. The effort to develop the mind must follow the attempt to restore the body to a healthy condition. The method of training for this purpose is similar to that employed in the instruction of idiots. In 1839 Dr. Guggenbuhl made the first systematic effort to treat cretinism. He opened an establishment at Abend-berg, near Interlaken, in Switzerland, and treated the disease with some success. After his death his institution was abandoned.
A few similar institutions have been established in Europe, and some schools for idiots also admit cretins; but the provisions for this purpose are far from adequate. A few years ago it was estimated that there were in Europe 50,000 cretins, while the institutions for their benefit had accommodation for only 250.