CRETINISM may be defined as an endemic idiocy, of which the characteristic is an arrested development of body as well as mind. The origin of the word is doubtful. its southern French form Chrestiaa suggested to Michel a derivation from cresta (crete), the goose foot of red cloth worn by the Cagots of the Pyrenees. The Cagots, however, were not cretins. Again Christianus (which appears is the Lombard cristanei, and the Savoyard innocents and Bens du bon diem) is merely a translation of the older cretin, which is probably connected with creta (craie) - a sail Jw or yellow-earthy complexion being a common mark of cretinism. Many other symptoms show that the whole organism is stunted. We quote the vivid picture by Beaupre, (Dissertation sm. les Cretins, translated in Mackie on Cretinism, Edin. 1855) : - "1 see a head of unusual form and size, a squat and bloated figure, a stupid look, bleared hollow and heavy eyes, thick projecting eyelids, and a flat nose. His fare is of a leaden hue, his skin dirty, flabby, covered with tetters, and his thick tongue hangs down over his moist livid lips. His mouth, always open and full of saliva, shows teeth going to decay. his chest is narrow, his back curved, his breath asthmatic, his limbs short, misshapen, without power. The knees are thick and inclined inward, the feet fiat. The large head drops listlessly on the breast; the abdomen is like a bag."

Generally the cretin is deaf and dumb, or able to sitter only a hoarse cry. He is indifferent to heat, cold, blows, and even the most revolting odours. Some appear to want intelligence altogether, and even the power of articulation. Others acquire the rudiments of language, and are able to perform simple tasks. There are, indeed, several distinct varieties of cretinism which have been noticed by Abercrombie, founding on the descriptions of Foddrd and De Saussure (De Fatuitate Alpine, Edin. 1803), Wenzel (Ueber d. Cretinismus, Vienna, 1802), and Guggenbfild of the Abendberg at Interlaken. The abnormal cranial deve. lopment has been studied by Virchow (Der Cretinisnius in Unteifranken, Witrzburg, 1852) and Vogt (.9lemoires sur les Microcephales, Geneva, 1867). Many cretins are by drocei,halie; but more frequently the skull is microcephalic, with premature ossification of the sutures and induration of portions of the brain matter. The anterior lobes are said to be much lighter than in healthy brains, but this difference does not extend to the cerebellum. Vogt maintains that the microcephale has a pithecoid skull at the crown, and a human skull at the base and crown. But his suggestion that this is a case of atavism, and that cretins 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 Lombroso and Valenti:of Bologna,Edim. 3fed. 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 brinks (Scotch). From this must be distinguished the weaver's goitre, caused by the emanations from steeped flax ; the exophtlialmic 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 dranl, water from a melting iceberg. The endemic goitre is a tumour of the thyroid 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, "goitre is the beginning of that degeneration of which cretinism is the end." No doubt, perfectly sane and healthy persons have goitres. For instance, Fodere, 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 Dauphine (Traite cu e 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, Malaearne wrote in 1789, Un mentecatto senza gozzo 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 I In the first place, the phenomenon is not confined 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 Viborg, and at the mouth of the St Lawrence ; on inland plains, like those of Lonlardy and Alsace ; at the moderate elevations of La Barthel, 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 Fodare 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 ; at Cuzco, where it rains, as the inhabitants say, thirteen months in the year, the disease is unknown. Morel, Virchow, and Koeberle (in his Essai sue 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 miasmic 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, successfully 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, overlooks 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 $arde, Turin, 1848). Milk and vegetable 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 havo changed from time to time. Every one knows Juvenal% line - " Quis tumidum gutter miratur in Alpibus I" and Shakespeare's " mountaineers, dewlapped like bulls, whose throats had hanging at 'em wallets of flesh." Catholic legends tell how in the 5th and 7th centuries Champagne and Liege were condemned for some sacrilege to have women 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. " Struma oritur ex metallicis et mineralibus aquis," says Paracelsus. Endemic goitre has been observed to increase when the 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 4 One opinion was that there might be too little iodine. The old practice of eating the ashes of sea-sponge led Coindet 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 the 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 stir les causes the cretinisme et du goitre endemigne, Paris, 1867. He takes the pathology of cretinism as illustrating the wider question of the dependence of the human organism on the chemical constitution of the soil. He has made an inquiry into the geological features of the districts in which cretinism is endemic, compared with the statistics of the cretin population. He finds that cretinism is confined to metalliferous districts, and occurs most frequently where iron pyrites and copper pyrites predominate.

Although dogs, pigs, and probably alsa horses, oxen, and sheep have been affected by goitre, there is no reliable evidence of a connection between goitre and feeble or stunted organization in any of the lower animals.

Pronounced cretinism seems to be incurable. Dr Guggenbiihl's treatment at the Abendberg was chiefly psychological, and belongs to the general theory of the treatment of idiots. But the Swiss commission, who reported on the Abendberg on 15th May 3849, say that the greater part of the inmates were not cretins at all, but merely scrofulous children. Accordingly on Guggenbiihrs death the Bern Government deelined any longer to support the establishment. Similar establishments have been founded at Marieuberg in Wiirtemberg by Dr Boesch, at Aosta in Piedmont, Basseno in Savoy, at Abbiategrasso in Lombardy, at Albany, Utica, and other places in the United States. (See, for a list of idiot schools, Die Heil um i Pfiege Anstalten far psycltisch. Kranke, by Dr H. Laehr, Berlin, 1875.) An institution at Highgate, London, was founded in imitation of the Abendberg. It may be interesting to note the places in which cretins have been found in the United Kingdom. In England these are Oldham, Sholver Moor, Cromp. ton, Duffield, Cromford (near Matlock), and other points in Derbyshire • endemic goitre has been seen near Nottingham, Chesterfield, Pontefract, Ripon, and the mountainous parts of Staffordshire and Yorkshire, the east of Cumberland, certain parts of Worcester, Warwick, Cheshire, Monmouth, and Leicester, near Horsham in Hampshire, near Haslemere in Surrey, and near Beaconsfield in Buckingham. There are cretins at Chiselborough in Somerset. In Scotland cretins and cases of goitre have been seen in Perthshire, on the east coast of Fife, in Roxburgh, the upper portions of Peebles and Selkirk, near Lanark and Dumfries, in the east of Ayrshire, in the west of Berwick, the cast of Wigtown, and in Kirkcudbright.

See Inglis, Treatise of English Bronchocele, 1844; Cretinism in Scotland, by Coldstream, 1847; Mitchell en the Nithsdale neck or goitre in Scotland, In Med. and Chir. Review 1862. See also Virchow, Pathologie des Tumeurs, Paris, 1863: Maffei, Der Orel. in den Norischen Alpen, Erlangen, 1844 ; Morel, Trade des BetpWrescences, Paris, 1817; Report of Royal Commission of Cretinism in Lombardy, Milan, 1864; Report of Austrian Commission, Vienna, 1861. (W C S.)