In the preceding chapters we emphasised the close relationship of endemic cretinism with endemic goitre, and the morphological and physiological inadequacy of the cretin thyroid gland, and have been confronted repeatedly by the similarity with the changes due to athyrosis in the pathological anatomy of the other organs – it has been almost like drawing a red line through our statement. You might therefore think that the pathogenesis of endemic cretinism conveniently involves a simple formula, and that this formula must relate to thyroid gland insufficiency. However, when you delve deeply into the whole problem area, here and there you come across facts whose explanation, as we have shown time and again, is not so simple. Similarly, deriving these hard facts from functional disorders of the thyroid gland function creates difficulties. This is very clearly expressed in Gamper’s recent critical discussion.