ESHS/HSS Annual Meeting

From Rare to Hiding in Plain Sight: ‘Cretinism,’ Goitre, and ‘Feeblemindedness’ in Interwar America

• In Event: Rarity in Medicine 2: Geographies and Politics

English Abstract

By the early nineteenth century, American physicians believed that goitre was a common condition, if limited to discrete geographies. Despite the fact goiter was common, most believed its more severe companion disorder– ‘cretinism’ – was rare in North America. Cretinism occurs when children lack significant iodine in utero (rather than in adolescence as in most goiter) hindering thyroid growth and causing a range of physical and mental disabilities. The ‘rareness’ of cretinism in North America compared to other goitrous regions shaped a century of discourse and allowed many to downplay the seriousness of the situation in the assessment of priorities in medical practice and public health. As late as the 1890s, William Osler only considered the condition only sporadic in American and Canadian asylums, a rarity rather than a communal threat.
This changed in the 1920s and 1930s when the concept of cretinism expanded to include nearly any connection between congenital damage to the thyroid and “feeblemindedness.” In the era that saw the framing of specific dietary ‘deficiency’ diseases, several surveys of goiter in public schools found a connection between low iodine levels and poor cognitive performance. The eugenic concern by the interwar years was no longer a few visible and ill ‘cretins’ but low maternal iodine levels resulting in thousands of ‘feebleminded’ children who would otherwise be ‘normal’. Contrary to the way its rareness limited research in the nineteenth century, a new conception of cretinism fueled the iodine-supplementation movement. This paper uses the history of goiter, cretinism, and the eugenics movement as an exemplar of what happens when the parameters of rarity change.

Author

• Sarah Naramore, University of Edinburgh