Etiology.—We arc as yet wholly ig norant as to what is the immediate cause of ordinary parenchymatous goitre, and, while very numerous apparently predis posing causes have been adduced, not one of these, so far as I can see, can be said to be in action in every case. In deed, at the present time too little care has been taken to distinguish between the various forms of goitre and to deter mine whether the sporadic cases are anatomically of the same character as those met with in regions where the con dition is endemic. It is, in fact, the ex istence of these sporadic cases which, to a large extent, renders it difficult to de termine the etiology of the condition. Certain conclusions can, however, be gained from a study of these predispos ing causes:— In regions where goitre is endemic— and it has been noticed both in Europe and on this continent (Michigan, Dock; Ontario,—Clark, quoted by Osier) —the domestic animals, dogs and horses, also present the condition.
Goitre occurs in all parts of Michigan. It is most prevalent in the northern part. Fifty-two reporters give a total of four hundred and seventy-seven cases. Lower animals almost always have goitre where it is common to man. George Dock (Boston Med. and Slug. Jour., July 4, '95).
No race appears to be exempt; the con dition has been found in all parts of the world, affecting all peoples. In America Munson has recently studied the prev alence of goitre among the Indians of the United States, and finds that the Crows, the Menoninees, and the North ern Cheyennes are particularly liable. At the same time among these tribes the disease is regional.
Of 147,873 Indians included in those reported on, 77,173 were inhabitants of goitrous tracts, in whom 1S23 eases of bronehoeele were found, or 2.36 per cent. This may be considered a minimum per centage, and the following conclusions arc arrived at from the facts quoted: 1. There is a strong racial disposition to goitre among the Indians.
2. It is a distinctly localized disease.
3. It does not appear to be caused by high altitudes, climate, or water contain ing excess of calcium-salts.
4. It is favored by unsanitary condi tions, constitutional depression, and im proper and excessively nitrogenous diet.
5. Hereditary influence is strongly marked.
6. Sex and puberty have a marked in fluence.
7. Cretinism and Graves's disease are rare; the former the rarer.
S. The tumors are smaller than among the whites, and treatment is unsatisfac tory. E. L. Munson ( N. Y. Med. Jour., Oct. 26, '95).
There can be no question that goitre manifests itself much more frequently and in general attains to a much greater size in the female than in the male. Sta
tistics upon this point are very variable; St. Sager gives the proportions of 44 to 1; but this would appear to be excessive in most localities. Fischer has collected statistics showing that from 80 to 90 per cent. of all cases of goitre—and of cases of myxcedema, 86 per cent.—occur in women, while exophthalmic goitre seems to attack the same sex chiefly.
As above stated, the condition may be congenital. In the absence of clear dence that a goitrous mother living in a non-goitrous region may give birth to children showing an already-developed goitrous condition, I am doubtful whether the condition can be truly said to be hereditary.
In 117 families in which one or more members suffered from goitre, all patients observed living in the town of Hamar and its environs, where the disease is frequently met with without being en demic, the disease had most frequently commenced in childhood, and rarely after the age of forty.
In 74 of the 117 families several mem bens suffered from goitre, and in 4S of these the disease appeared in the di rect ascending or descending line, while it appeared only in the lateral branches in but 26 cases. Hemicrania, and this only in its typical form, was a symptom very frequently met with—both in the patients with goitre and in their rela tions with no goitre. Goitre considered as being of vasomotor origin. Vet lesen ("Etiological Researches Concern ing Goitre," '87).
Seven cases of goitre observed in the same family. L. F. Mial (Jour. of Laryng., Mar., '96).
Kocher, who regards goitre as the first stage on the road leading to cretinism, holds similar views with regard to the congenital as opposed to the inherited nature of that disease.
As already stated, there appears to be a very close relationship between disor ders of the thyroid and the sexual func tions. We are as yet wholly ignorant as to what is the nature of this relationship.
Two cases in which hypertrophy of the spleen coincided with an increased vol ume of the thyroid gland. The functions of the spleen were destroyed by disease. The hypertrophy of the thyroid is in re lation with the abolition of the function of the spleen. Cardone (Archivii Italiani rli Laringologia, Pt. 4, 'SS).
In a case of sarcoma of the thyroid, in which tracheotomy failed to relieve dyspncea, caused by pressure on the pneumogastric, irritation of the mu cous membrane of the trachea gave tem porary relief. J. Solis-Cohen (N. Y. Med. Jour., Aug. 10, 'SS).