Endemic Cretinism

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.

First English language translation of classic text

IntroductionChaptersI. Etymology of the word 'cretin'  (Wegelin)II. Definition  (de Quervain)III. Historical (Wegelin)IV. Epidemiology (Wegelin)1.  Statistics2.  Geographical distributionEuropeAsiaAustraliaAfricaAmerica3.  Racial affinity4.  Relation to endemic goitreV. Course and clinical pattern of cretinism (de Quervain)Cretinism with and without goitreGrade of cretinismDevelopment of cretinsDeteriorationSpontaneous recoveryInfluence of endemic goitre on children1.  The sexual distribution of cretinism2.  The behaviour of physical developmentGrowth in non-goitrous cretinsGrowth in goitrous cretinsDevelopment quotienta)  The individual  parts of the skeletonBehaviour of the skullCranial capacityDentitionRemainder of skeletonAppearance of centres of ossificationJointsCretin hipsHumerus varusPelvisb)  The skin and its appendagesMyxoedemaSkin shadeDryness of the skinHair growthc)  The musculatured)  The behaviour of the endocrine glandsThe thyroid glandAtrophy of the thyroidCretinous goitreThe parathyroid glandsThe sexual glands and the sexual organsHypophysise)  The intestinal tract and its glandsf)  The blood vascular systemHeartCapillary structureg)  The nervous systemMobilityNeuromuscular systemTendon reflexesMacCarrison's 'Nervous cretinism'Sense organs    Hearing disordersSpeech disordersAutonomic nervous system3.  The intellectual behaviour of cretinsMental debilityIntellectual developmentAcquisitive instinctImitative behaviourSelf-awarenessEmotionsSociabilityGratitudeSexual behaviourPsychological functions in relation to body typeVI.  Pathological anatomy and histology (Wegelin)1. Thyroid glandEpithelial changesSclerosisLymphocyte infiltrationVascularizationRegenerative epithelial growthNodular goitreMalignant epithelial goitrVascularisation of nodular goitreFunctional behaviour of the thyroid glandDiffuse goitre'Niduses' of squamous epitheliumDispersed aggregations of parathyroid cells and remnants ofthe ultimobranchial body2. Parathyroid glands3. Thymus4. Hypophysis5. Pineal gland6. Suprarenal glands7. GonadsA.  Male gonadsB.  Female gonadsOvariesUterus                Breasts8. Nervous systemMeningesBrainSpinal cordPeripheral nerves9. Musculature10. The skeletonGeneral restriction in growthPhysical proportionsDevelopmentBone form relationshipsSkullTrunkUpper limbsLower limbs11. Joints12. Teeth13. Skin and subcutaneous tissue14. Ear15. Circulatory system    HeartArteriesCapillaries16. Blood, and blood-forming organsBloodBone marrowLymph glandsSpleen17. Respiratory organs18. Digestive organsTongueStomach and intestinePancreasLiverGall bladderPeritoneum19. Urinary system20. Further anatomical findingsMalformationsBlastomaTuberculosisSyphilis21. Lifespan and diseases of cretinsAverage ageCauses of death22. Cretinism in animals23. SummaryVII.  Pathological physiology  (de Quervain)Endemic thyropathyMetabolismAlbumen and salt metabolismCarbohydrate metabolism and basal respiratory metabolismBlood examinationBlood clottingSedimentation rate of red blood cellsDispersion grade of blood albumen bodiesAnalysis of the individual fractions of albumen bodies in the bloodby weight determinationPhagocytic activity of leucocytesIon relationships in the bloodIodine distribution among cretinsAnalysis of the iodine level in the bloodTesting of thyroid gland function, after Asher-StreuliFunctional behaviour of the liverBasedow appearance among cretinsVIII.  Pathogenesis  (de Quervain and Wegelin)Comparison of cretinism with congenital athyrosis, spontaneousmyxoedema and postoperative myxoedemaScheme of possible influences of the goitre-noxaPossibility of a dysthyrosisOccurrence of thyroid gland atrophy    Congenital goitre among cretinsComparison of the anatomical findings with thoseof congenital athyrosisDissociation of symptomsDifferent threshold values of thyroid gland functionHeredityGoitre in the motherGeographical dependence of goitre and cretinismInbreedingSignificance of local factorsRelationship with Status degenerativusQuestion on the occurrence of genotypically-inheritablenon-site-dependent diseases due to the goitre-noxaVarying powers of resistance to the goitre-noxaGoitre investigations in twinsQuestion about direct exogenous influence on the embryoPossibility of direct exogenous influence of other endocrine glandsby the goitre-noxaNervous cretinismQuestion on the inadequate functioning of the other endocrine glandsOccurrence of hearing disordersIX.  Prophylaxis and Treatment of Cretinism  (de Quervain)'Racial hygiene'Improvement of the hygiene of living conditionsRadioactivity of the soilCombating the goitre-noxa by iodine in small dosesProphylaxis through iodised cooking saltIodine supplement during school ageIodine supplement for the pregnant motherThe question of sterilizationImplantation of thyroid gland tissueSubstitution therapy with thyroid gland preparationsIodine treatmentGoitre surgery among cretinsGoitre and cancerReferencesAppendix