Page:Encyclopædia Britannica, Ninth Edition, v. 6.djvu/607

Rh CRETIN IS M 573 represent a stage through which the human race passed in its evolution from the ape is generally repudiated. (See the Races of Man by Oscar Peschel, London, 1867, p. 66, and a paper by Dr Ireland of Larbert on the Reports of Drs Lorn broso and Valenthof Bologna,-Se?Mi. Med. Journal, xx. p. 109). It is said too that the respiration of cretins reaches only 15 instead of the normal 18 per minute. Many die very young in epileptic convulsions, and survival to old age is extremely rare. But the most striking sign of cretinism is the goitre, variously known as bronchocele and struma, kropf (German), wen or derby neck (English), mumps or b ranks (Scotch). From this must be distin guished the weaver s goitre, caused by the emanations from steeped flax ; the exophthalmic goitre, also called Grave s disease, which is marked by palpitations of the heart and prominence of the eyeballs ; and the smaller goitre which is sometimes connected with uterine affections. We should also mention the epidemic goitre, such as that which attacked Captain Cook s crew in 1772, when they drank water from a melting iceberg. The endemic goitre is a tumour of the thj roid gland of varying size, sometimes filled with a viscous fluid, sometimes containing pus cysts and calcareous deposits. There is a large body of evidence to the effect that goitre and cretinism are causally related, that they are at least effects of the same causes ; or, as Maffei expresses it, &quot;goitre is the beginning of that degener ation of which cretinism is the end.&quot; No doubt, perfectly sane and healthy persons have goitres. For instance, Fode&quot;re&quot;, an eminent man of science who published an Essai sur le Goitre at Turin in 1792, himself suffered from this deformity when a boy, and re-caught it when lecturing at Strasburg. But these cases are few, and the statistical inquiries of Roesch in Wurtemberg ( Ueber d. Cretinismus, Erlangen, 1844), and of Niepce in Dauphin e 1 (Traite du Goitre et du Cretinisme, Paris, 1852), have established that the great mass of cretins have goitres, and that goitre generally appears at the age when development is arrested, that is, seven or eight years. Of Aosta, the home and centre of cretinism, Malacarne wrote in 1789, Un mente- catto senzayozzo e una cosa rarissima. The two things have been observed together in Africa and both Americas by Park, Richardson, Humboldt, and other distinguished travellers. Again cretinism is found in certain districts , it is in these districts also that the non-cretinous cases of goitre are for the most part found. Healthy parents, coming to an endemic district, produce children with goitres, or cretins ; parents with goitres, removing to an untainted neighbourhood, often lose their own goitres, and seldom produce children subject to the deformity. Nor does intermarriage with a healthy stranger avert the danger, if the household remain subject to the endemic conditions. It may be added that in both Europe and the United States deaf mutism, a form of arrested development, is found in local contact with cretinism and goitre. Deaf- mutes are often found in families of which the other members are cretins, and they are found as a class in the neighbourhood of a cretin district. What then are the causes of cretinism, of which we shall take goitre as a symptom ? In the first place, the phenomenon is not con fined to any one race. The whites, the Indians, the negroes, and the half breeds of Central and South Africa all exhibit the disease in certain localities. So do the Malays and the Dyaks of Borneo, the Mongolians of Nepaul, Siberia, and the Kwang Tung Mountains in China, the Berbers of Mount Atlas. Nor is it confined to one elevation or character of surface. It appears on the sea shore, as at Yiborg, and at the mouth of the St Lawrence ; on inland plains, like those of Lom bardy and Alsace ; at the moderate elevations of La Barthe and Luz in the Pyrenees ; and on the high Peruvian plateau of Pasco, and in the Himalayan valley of the Jumna. Nor can any thermic conditions be laid down ; for the symptoms range from the deserts of Algeria to Irkutsk in Siberia, from an average temperature of 80 Fahr. to one of 14 Fahr. The idea of Fodere&quot; that cretinism is caused by a humid atmosphere does not receive much encouragement from the facts. Peru has a very dry climate, and goitre is the principal endemic ; the British Isles with much rain and fog have little or no cretinism ; atCuzco, where it rains, as the inhabitants say, thirteen months in the year, the disease is unknown. Morel, Virchow, and Koeberle&quot; (in his JSssai sur Cretinisme, Strasburg, 1862) have maintained that cretinism is caused by a special form of marsh-fever, malaria, or even a special organic poison-germ in the atmosphere. The maximum of niiasmic fever, however, has a geographical habitat very different from that of cretinism, which frequently occurs in a rare atmosphere, impregnated with ozone. Hygienic regulation, too, suc cessfully resists cretinism, while respiration is sufficient to let in the atmospheric poison. The favourite explanation of De Saussure, that cretinism is caused by the stagnation of air in the deep valleys of the Alps and Pyrenees, over looks the well-known fact that morning and evening winds regularly ventilate these valleys. Proceeding on this error, the Sardinian commission recommended that trees near dwelling-houses should be cut down (see Rapport de la Commission Sarde, Turin, 1848). Milk and vege table diet, various kinds of farinaceous food, and defective hygiene, have also been made responsible for the disease. But it is not only the poor, the ill-fed, and ill-clad who contract goitre and become idiots ; persons in comfortable circumstances, living with every regard to cleanliness, in a fertile country under a fine climate, are subject to the ailment. In Piedmont, for instance, it was calculated that less than three-fifths of the cretins belonged to the poor people ; of course poverty aggravates every disease. The general result of these abortive theories is that some local telluric conditions must be ascertained. There are fragments of evidence showing the persistence of cretinism in particular localities, the inhabitants of which have changed from time to time. Every one knows Juvenal s line &quot;Quis tumidum guttur miratur in Alpibus?&quot; and Shakespeare s &quot; mountaineers, dewlapped like bulls, whoso throats had hanging at em wallets of flesh.&quot; Catholic legends tell how in the 5th and 7th centuries Champagne and Lie&quot;ge were condemned for some sacrilege to hava w-omen with goitres. The Life of Charlemagne states that in 772 his soldiers caught the goitre on the banks of the Rhine. It has always been a popular as well as a scientific belief that water is the vehicle of the poison. &quot; Struma oritur ex metallicis et mineralibus aquis, &quot; says Paracelsus. Endemic goitre has been observed to increase when tho summer heats altered the chemical character of the water used for drinking and cooking ; and it sometimes disappears before modern arrangements for water supply. Goitre has in fact been artificially produced by the use of water, for the purpose of evading the conscription. But the question remains what is the poison thus conveyed ? One opinion was that there might be too little iodine. The old practice of eating the ashes of sea-sponge led C oindet of Geneva to apply iodine to goitre with success. It was also maintained that there might be a deficiency of the phosphates of lime and magnesium. These views apparently proceeded on tho principle that the human body required a certain normal proportion in the chemical elements which it consumed. The whole subject has been elaborately treated by M. St Lager in Etudes sur les causes du cretinisme et du goitre endemiqne, Paris, 1867. He takes the pathology of cretinism as illustrating the wider question of the depen dence of the human organism on the chemical constitution