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Researches on Cretinisim in General, and Abstract of the Report of The M. Boudirfs Researches on Cretinism. 41 Art. III.- -Researches on Cretinism in general, and Abstract of the Report of the Commission named by the King of Sar- dinia, in order to study this Infirmity. By M. Boudik, Surgeon in Chief to the Military Hospital of Roule. (Ar- chives Generales de Medecine, 4ieme series, T. xxiv. Sept. 1850. P. 65.) For several years the governments of various States have been occupied in investigations which show their anxiety for the welfare' of their respective populations, while they prove that the import- ance of questions relating to public hygiene is beginning to be understood. At the head of the most remarkable of the labours re- sulting from these new tendencies, must be placed the report of the commissioners appointed by the English government for inquiring into the sanitary state of large towns and populous villages in Eng- land, and the statistical reports upon the army and navy of Great Britian. Ten years back, the Helvetic Society of Natural Sciences ap- pointed a commission to collect the materials of statistical history of cretinisim in Switzerland. Want of funds and consequent organisation caused the failure of this happy proposition, which, being resumed afterwards in the health councils of the Cantons, will probably produce in their hands better results. Lastly, in 18451 the Piedmontese government appointed a Commission to proceed on an inquiry upon cretinism in the Sardinian States.* This Commission, after having applied to the assemblage of curates, and of all the physicians of the kingdom ; and having procured by this means the first information, instructed one of its members, M. Trombotto, to visit the localities specified as possessing Cretins, in order to examine the condition of those persons more narrowly. The researches of this physician, conjoined with five hundred and nineteen returns (519), furnished by the curates of the communes, and with ninety-four memoirs of physicians have been employed as the basis of the report published in 1848 by the Sardinian go- vernment. A succinct summary of this we shall endeavour to present. " The Commission defines Cretinism to be a Degeneration of the Human Race, showing itself in certain regions of the globe, and characterized by a degree of idiocy more or less marked, as- sociated with a.vitiated habit of body ; and the formation of which depends on causes so extensive, that, in a large portion of the in- habitants, their operation is displayed in a degree greater or less * The Commission consisted of M. Gallo, Professor of Surgery, as President; M. Despine, Inspector of Mines ; Riberi, Professor of Surgery; Bonino, Physi- cian in Chief to the Army ; Sismonde, Professor of Mineralogy ; Cantu, Professor of Chemistry ; Bertini, Gene, Bellingeri, Professors or Councillors of the Faculty of Turin ; and lastly, M. Trombotto. 42 M. Boudill's Researches on Cretinism in the regularity of their forms and in the development of intel- ligence, and of the person." The ancients have been silent on the subject of cretmismj and the first mention of this disorder is probably found at the com- mencement of the sixteenth century in the following passage from Felix Plater. Some madmen also there are, who, besides innate insanity, are marked by nature with certain defects. Some of these occur in different places, but they are principally found in greater ^numbers in certain regions, for example the Canton and district *of Valais, called Bremis; many of them sitting in the high ways, some of whom were brought to me. I saw them sometimes dumb, with an immense swollen tongue, at the same time in some instances with a swelling in the neck, with deformed ap- pearance. These persons placed before their houses were gazing at the sun with a fixed stare, and with staves between their fingers, and writhing their bodies in various directions, with open gaping mouth, excited the laughter and wonder of those who passed by."* Towards 1574, Simler, in a description of the Valais, expressed himself on this subject in the following terms. As to Valais, in some cantons several goitrous patients are found;*in others almost none; in some very few. A friend wrote to me that he knew one canton in which are several lame persons, while in the neighbouring canton no one labours under this infirmity. He further states, that there is a canton in which are found several fatuous persons whom they call Gouchen, who scarcely deserve to be called men, being similar to the lower ani- mals in using no human food ; and that he had seen one of these use horse dung, another who eat hay, and others who went naked the whole winter, and various wonders of the same description, the cause of which is unknown.,,-f- Cretinism, mentioned in 1660 by Forest, in 1680 by Wagner, * F. Plateri, Observationes in hominis affectionibus plerisque. Basileae, 1714. Sunt et aliqui stulti qui praeter innatam stultitiam vitiis quibusdam notati sunt a natura : quorum aliqui passim occurrunt, maxime, vero in certis regionibus frequentiores inveniuntur, uti in Valesio pago, Bremis appellato; plurimos in viis sedentes, quorum aliqui ad me Sedunum delati fuerunt. Vidi interdum lingua immensa et tumida, mutos, strumoso simul aliquando gutture, aspectu deformi, qui ante suas aedes collocati torvo visu solem intuebantur, ac bacillis dK gitorum interstitiis inditis corpusque varie torquentes,oreque diducto, cachinnum et admirationem paetereuntibus movebant. t Quod Valesianos spectat, in quibusdam pagis complures gutturosi inveniuntur, in aliis in prorsus nulli, quibusdam pauci admodum. Alium quoque pagum se illis nosse amicus ad me in quidam scripsit, quo plures claudicant, quum in nemo tali vitio proximo pago laboret. Item pagum esse in quo plures homines fatui inveniuntur, quos ipsi Gouchen vocant, qui vix homines nominari merentur, bestiis similes ut qui nullo cibo humano utantur; se enim vidisse qui stercore equino uteretur, alium qui faeno, alios qui nudi tota hyeme incederent, et varia huiusmodi monstra, quorum causa in occulto latet. M. BoudirTs Researches on Cretinism. 43 and in 1771 by Haller, was described by Sauvages, Ramond de Carbonnieres, and by Fodere towards the end of the eighteenth century. Since that time, a great number of monographies having reference to this affection have successively appeared. I con- fine myself to the publication of Michaelis upon Cretinism in the Harz ; to that of Haquet in Styria and Carinthia ; and some good recent monographies.* Cretinism has been observed in Europe, in the Alps, the Py- renees, Jura, the Harz, and the Carpathian Mountains; in Ame- rica, in the Cordilleras; in Asia, in the Himalaya range, in the mountains of Thibet, of Tartary, of China. I have never seen it in Algeria ; but I have been assured that some cretins have been seen in the mountains of Atlas. Lastly, cretinism has been observed in Bambarra, in the valley of the Niger, and at Madagascar. In the Sardinian States the principal centre of cretinism is represented by the valleys of the Greek and Pennine Alps; (Alpes Graice, Alpes Pennince;) which surround Mont Blanc, the valley of the Doire-Baltee, the valley of the Isere, of the Are, of the Arve, and that of the Oreo. Among a population of 4,125,740 inhabitants, of which about one-half occupies the mountains, and the other half dwells in the plains, there have been enumerated 21,341 goitrous persons, and 7084 cretins. In France the Counsels of Revision declare annually, from 1200 to 1300 exemptions on the ground of Goitre; and it is to be remarked that the largest proportion is furnished by the single * Beobachtungen und Bermerkungen uber den an beiden Ufern der Donau in Ober und Unter-Oesterreich haufig vorkommenden Cretinismus (Oester. med. WochenschrifTt, 1848. No. 44). J. M'Clelland, Geology of Kemaon. Dublin Journal, 1837. Demtne, Ueber endemischen Cretinismus, Eigenthum der Rettungsanstalt fur Cretinen auf dem Abendberg Bern, 1840. Buek, Vortrag uber Cretinismus und die Moglichkeit demselbem vorzubeugen. Hamburg, 1842. Otho Thieme, Der Cretinismus. Weimar, 1842. Rosch, Die Stiftung fur Cretinenkinder auf dem Abendberg. Stuttgard, 1842. Berchtold-Beaupre, Dissertation sur le cretinisme. Fribourg, 1843. (Brochure dont je suis redevable a l'intelligence de M. Guggenbiihl.) Twining, Some Account of Cretinism and the Ins itution for its cure on the Abendberg in Switzerland. London, 1843. Extracts from the First Report of the Institution on the Abendberg for the Cure of Cretins, translated by Dr W. Twining. London, 1843. Maffei und Rosch, Neue Untersuchungen iiber Cretinismus. Erlanj. en, 1844. Michaelis, Skizzen von der Verbreitung des Cretinismusim Kanton von Argau, Aarau, 1843. Edward Wells, Essay upon Cretinism and Goitre. London, 1845. D. A. Chavannes, des Cretins a l'Abendberg (Journal de la Societe Vaudoise d'utilite publique, No. 145. Lausanne, 1844). Verhandlungen der Schweiz., naturforschenden Gesellschaft, iiber Cretinismus, zu Freyburg, Zurich, Lausanne, Chur und Genf; 1840. Beobachtungen iiber den Cretinismus, eine Zeitschrift herausg. v. d. Aerzten der Heilanstalt Mariaberg. 1. Hft? grand in-4 (iv.-103 S. m. 2 lith.). Tubin- gen, 1850. 44 M. BoudiiTs Researches on Cretinism. department of the High Alps. Thus, there are calculated as exemptions in consequence of goitre; in the department of the High Alps. In 1837 1361 105 ? 1839 1357 86 ? 1840 1281 115 ? 1841 1207 56 ? 1842 1241 80 The following table presents from Piedmont the distribution of Goitre and Cretinism according to the provinces. Cretins in every Provinces. Population. Goitrous. Cretins. 100 inhabitants. Savoy Proper, 148,844. 587 304 *20 Upper Savoy, 49,758 1054 362 k72 Chablais, 54,686 133 87 *16 Faucigny, 101,792 741 ^04 49 Genevois. 100,905 ... 12 .01 Maurienne, 62,344 4339 1418 2*27 Tarentaise 46,688 2160 679 1*45 Aosta, 78,110 3554 2180 2'79 Turin, 369,677 20 29 *07 Ivrea, 160,574 1643 418 *25 Pignerol, 126,998 594 189 *14 Susa, 78,036 82 32 .
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