Case of supposed goitre which was found to be a great hypertrophy of both sterno-mastoid muscles resulting from extreme dyspncea, due to a post-mann brial tumor (probably enlarged glands) pressing on the bifurcation of the trachea. Foxwell (Brit. Med. Jour., Apr. 1S, '91).
It is suggestive to note that, as pointed out by Gaskell in his address in the Physiological Section at the meet ing of the British Medical Association in Liverpool in 1S90, in forms which may be regarded as occurring along the line of vertebrate ancestry, the primal sexual organs lie in immediate connection with the laryngeal depression or groove from which the thyroid is developed; indeed the thyroid in these is a sexual organ. Certain it is that the thyroid is liable to show marked enlargement at the time of puberty, during menstruation, and dur ing the period of child-bearing, and, again, that a very large number of cases of goitre are traced back, both in man and woman, to the time of puberty or of other marked disturbance in the sex ual organs. The slighter sexual disturb ances of the thyroid are apparently of the nature of an hypermia. This by percemic condition if continued would seem to lead to more extensive parenchy matous changes.
Thyroid enlargement is very frequent in women who have uterine fibromvoma. In 56 eases of a gyncecological affection with enlarged thyroid, 44 times the for mer was a fibromyoma. Freund (Gaz. Mild. de Paris, Oct. 10, '91).
Goitre, common in a certain district, ascribed to increased blood-supply to the thyroid, due to the exertion consequent on carrying water in vessels upon the head. Thomas A. Glover (Brit. Med. Jour., July 13, '95).
In Switzerland Kocher finds, in study ing no less than 76,000 school-children, that before the seventh and eighth years goitre is an exception, the condition in creasing in frequency up to the thir teenth and fourteenth years.
Frequency of goitre at different times of life. Of 13.090 cases only 2209 were younger than 20 years. Between 36 and 40 there were 1371; between 56 and 60 the number fell to S7S. Mayet (Lyon Med., Apr. 15, 1900).
It is equally clear that goitre in gen eral is endemic and that the vast major ity of cases occur in certain well-defined areas. More especially is the condition found in mountainous regions, but not all; for example, it is not found in the Jurassic regions, or, again, according to Bircher, where the rocks are of fresh water' formation. Bircher's map of the
distribution of goitre in middle Europe shows this relationship to mountainous districts very clearly, but shows, also, that the presence of high mountains and deep valleys is far from necessary for the development of endemic goitre. Fre quent cases are found in the flat coun try stretching from the north of Paris toward Belgium and along the valley of the Thames. On this continent Mich igan and the Island of Montreal, where cases are very frequent, are in general flat and low-lying districts, nor is the goitrous area in Ontario mountainous. Dock points out that in America goitres are found as well with drift as on the Laurentian and many intermediate for mations.
In certain provinces of Bolivia the In dians suffer much from goitre. These same Indians are clay-eaters; the clay is composed of silica, alumina, lime, mag nesia, protoxides of iron and manganese, potash, water, and organic matter. Al bert S. Ashmead (N. Y. Med. Jour., Aug. 24, '95).
Numerous authorities have attempted to show that the composition of the water ordinarily drunk bears a direct re lationship to the development of goitre. But here again the evidence is very con flicting. It may be briefly stated that the presence or absence of chalk or of magnesia or iron and other mineral con stituents, the carrying of heavy loads upon the head, intermarriage and sev eral other factors due to surroundings and habits of life, must all be given up as possible factors in the causation of this disease. Yet there can be little doubt that the water consumed is an important factor. In Switzerland Kocher found that in the affected districts competent inhabitants are able to point out foun tains whose water without exception has caused goitre in children who drank it, while families which had a private water supply were free from the affection. In one village, too, he was able to guish those who drank from one supply from those who obtained their water from another by the existence or non existence of goitre.