Endemic Cretinism

DESCRIPTION

Responding to a renewed interest in the growing problem of iodine deficiency worldwide, Drs. Charles Oxnard and Peter Obendorf, along with experienced translator and anatomist John Dennison, take a fresh look at the classic text, Der endemische Kretinismus, published in 1936 by Springer. Translated here for the first time into English, this landmark text will be a welcome resource for researchers confronting the problem of iodine deficiency. Oxnard and Obendorf point out that there is very little detailed knowledge or numerical data on cretinism available in the English-speaking world. In addition, highly-renowned Professor Basil S. Hetzel, recently-retired World Health Organization Chairman of the International Council for Control of Iodine Deficiency Disorders, published in 2009 with Dr Chen Zu-pei on the resurgence of iodine deficiency in China. Indeed, throughout the entire developing world there may be as many as two billion people at risk to iodine deficiency; perhaps three quarters of a billion have goiter, and ten million may be cretins. Even in developed countries, iodine deficiency is re-emerging (as in New South Wales in 19% of children) with the result of significantly reduced numbers of gifted children (though this is not cretinism per se). Certain to be of significant interest to a wide range of researchers, health providers and professionals, including government health administrators, this English translation of Endemic Cretinism is a major contribution to the literature.

TABLE OF CONTENTS

• Introduction
• Chapters

• I. Etymology of the word ‘cretin’ (Wegelin)

• II. Definition (de Quervain)

• III. Historical (Wegelin)

• IV. Epidemiology (Wegelin)
1. Statistics
2. Geographical distribution
• Europe
• Asia
• Australia
• Africa
• America
3. Racial affinity
4. Relation to endemic goitre

• V. Course and clinical pattern of cretinism (de Quervain)
• Cretinism with and without goitre
• Grade of cretinism
• Development of cretins
• Deterioration
• Spontaneous recovery
• Influence of endemic goitre on children
1. The sexual distribution of cretinism
2. The behaviour of physical development
• Growth in non-goitrous cretins
• Growth in goitrous cretins
• Development quotient
• a) The individual parts of the skeleton
• Behaviour of the skull
• Cranial capacity
• Dentition
• Remainder of skeleton
• Appearance of centres of ossification
• Joints
• Cretin hips
• Humerus varus
• Pelvis
• b) The skin and its appendages
• Myxœdema
• Skin shade
• Dryness of the skin
• Hair growth
• c) The musculature
• d) The behaviour of the endocrine glands
• The thyroid gland
• Atrophy of the thyroid
• Cretinous goitre
• The parathyroid glands
• The sexual glands and the sexual organs
• Hypophysis
• e) The intestinal tract and its glands
• f) The blood vascular system
• Heart
• Capillary structure
• g) The nervous system
• Mobility
• Neuromuscular system
• Tendon reflexes
• MacCarrison’s ‘Nervous cretinism’
• Sense organs Hearing disorders
• Speech disorders
• Autonomic nervous system
3. The intellectual behaviour of cretins
• Mental debility
• Intellectual development
• Acquisitive instinct
• Imitative behaviour
• Self-awareness
• Emotions
• Sociability
• Gratitude
• Sexual behaviour
• Psychological functions in relation to body type

• VI. Pathological anatomy and histology (Wegelin)
1. Thyroid gland
• Epithelial changes
• Sclerosis
• Lymphocyte infiltration
• Vascularization
• Regenerative epithelial growth
• Nodular goitre
• Malignant epithelial goitr
• Vascularisation of nodular goitre
• Functional behaviour of the thyroid gland
• Diffuse goitre
• ‘Niduses’ of squamous epithelium
• Dispersed aggregations of parathyroid cells and remnants of
• the ultimobranchial body
2. Parathyroid glands
3. Thymus
4. Hypophysis
5. Pineal gland
6. Suprarenal glands
7. Gonads
• A. Male gonads
• B. Female gonads
• Ovaries
• Uterus Breasts
8. Nervous system
• Meninges
• Brain
• Spinal cord
• Peripheral nerves
9. Musculature
10. The skeleton
• General restriction in growth
• Physical proportions
• Development
• Bone form relationships
• Skull
• Trunk
• Upper limbs
• Lower limbs
11. Joints
12. Teeth
13. Skin and subcutaneous tissue
14. Ear
15. Circulatory system Heart
• Arteries
• Capillaries
16. Blood, and blood-forming organs
• Blood
• Bone marrow
• Lymph glands
• Spleen
17. Respiratory organs
18. Digestive organs
• Tongue
• Stomach and intestine
• Pancreas
• Liver
• Gall bladder
• Peritoneum
19. Urinary system
20. Further anatomical findings
• Malformations
• Blastoma
• Tuberculosis
• Syphilis
21. Lifespan and diseases of cretins
• Average age
• Causes of death
22. Cretinism in animals
23. Summary

• VII. Pathological physiology (de Quervain)
• Endemic thyropathy
• Metabolism
• Albumen and salt metabolism
• Carbohydrate metabolism and basal respiratory metabolism
• Blood examination
• Blood clotting
• Sedimentation rate of red blood cells
• Dispersion grade of blood albumen bodies
• Analysis of the individual fractions of albumen bodies in the blood
• by weight determination
• Phagocytic activity of leucocytes
• Ion relationships in the blood
• Iodine distribution among cretins
• Analysis of the iodine level in the blood
• Testing of thyroid gland function, after Asher-Streuli
• Functional behaviour of the liver
• Basedow appearance among cretins

• VIII. Pathogenesis (de Quervain and Wegelin)
• Comparison of cretinism with congenital athyrosis, spontaneous
• myxœdema and postoperative myxœdema
• Scheme of possible influences of the goitre-noxa
• Possibility of a dysthyrosis
• Occurrence of thyroid gland atrophy Congenital goitre among cretins
• Comparison of the anatomical findings with those
• of congenital athyrosis
• Dissociation of symptoms
• Different threshold values of thyroid gland function
• Heredity
• Goitre in the mother
• Geographical dependence of goitre and cretinism
• Inbreeding
• Significance of local factors
• Relationship with Status degenerativus
• Question on the occurrence of genotypically-inheritable,
• non-site-dependent diseases due to the goitre-noxa
• Varying powers of resistance to the goitre-noxa
• Goitre investigations in twins
• Question about direct exogenous influence on the embryo
• Possibility of direct exogenous influence of other endocrine glands
• by the goitre-noxa
• Nervous cretinism
• Question on the inadequate functioning of the other endocrine glands
• Occurrence of hearing disorders

• IX. Prophylaxis and Treatment of Cretinism (de Quervain)
• ‘Racial hygiene’
• Improvement of the hygiene of living conditions
• Radioactivity of the soil
• Combating the goitre-noxa by iodine in small doses
• Prophylaxis through iodised cooking salt
• Iodine supplement during school age
• Iodine supplement for the pregnant mother
• The question of sterilization
• Implantation of thyroid gland tissue
• Substitution therapy with thyroid gland preparations
• Iodine treatment
• Goitre surgery among cretins
• Goitre and cancer

• References
• Appendix