Goitre in England is most prevalent in the carboniferous limestone regions. James Berry (Brit. Med. Jour., June 13, 20, 27, '91).
The following conditions accompany the production of goitre: (1) absence of hygienic care, material and intellectual poverty; (2) age-12 to 15 years; (3) presence in the water of notable quanti ties of lime and magnesia (not absolutely general); (4) altitude; (5) carrying large burdens causing bending of the head, and bending of the head during work: (6) acute phenomena which seem to indicate an infectious origin. Venous stasis is a predisposing and infection a determining cause (existing in the waters or air of certain countries). The infec tion may run an acute course. Froelich (Revue Med. de l'Est, Nov. 15, '91).
In a district having a population of about two thousand, the writer has had fifty-five cases of goitre under his care in the past two and one-half years. The soil of the district is excessively chalky. and, with few exceptions, the water supply is obtained from deep wells sunk into the chalk. When the springs are low the water is drawn up and even con sumed while still milky in color. The people who live on the tops of the hills and who drink stored rain-water are not affected with the disease. H. C. L. Morris (Brit. Med. Jour., July 6, '95).
In the hills of Cumberland and West moreland, where goitre is endemic, iron, copper, and lead are found in large quan tities. Paracelsus and other physicians of the sixteenth and seventeenth cent uries accused metallic waters of causing the neck to swell, and even mention iron pyrites as a cause of goitre. Louis E. Stevenson (Lancet, Dec. 14, '95).
More than 76,000 school-children be tween the ages of 7 and 16 reviewed with their parentage and antecedents. The investigations were principally made in the canton of Berne, Switzerland.
The formulated results may be briefly stated as follows: The female is more frequently the victim of goitre than the male. In children between the ages of 9 and 14 years goitre reaches its highest degree of frequency, and rarely appears before they are sent to school, where the position or the head in writing and reading gives a tendency to the ailment. There is, therefore, a school-goitre. The secondary changes in the thyroid are proportionate to the advanced age of the subject. Congenital goitre is extremely
rare. A still greater exception is con genital atrophy of the thyroid. The districts supplied with water from the fresh-water sandstone showed a preva lence of goitre, while in the districts in which the water originated from salt water sandstone goitre was infrequent. The prevalence of goitre depended upon the abundance of organic elements in the water rather than upon its source, and that neither deficient nourishment, un healthy dwellings, nor wretchedness and poverty is a direct causation. Often the districts rich in goitre are separated by narrow limits from those free from the disease and in goitre-laden localities were oases free from goitre. There were actual goitre-fountains, the water of which almost invariably produced goitre in the children that drank it. On the other hand, in localities where goitre was prevalent families who had a private water-supply were sometimes free from infection. Brooks and rivers and long open conductors of water were unfavor able. Kocher (Correspondent of Boston Med. and Surg. Jour., June 24, '97).
Study of causation of goitre in a dis trict in India 2000 feet above sea-level. Strong evidence pointing to an organic rather than a mineral cause. The soil is extremely porous. The water contains no more than a moderate amount of organic matter and mineral constituents, is soft or moderately hard, and, except for minute traces, is free from iron.
The inhabitants, who live under the same climatic conditions, but with differ ent occupations, may be divided into two classes: the native Bhutias and the Sepoy troops from the northwest prov inces. The former are omnivorous, but, by reason of poverty, mostly vegetarians. Their chief diseases are goitre, syphilis, and malaria. The temporary inhabit ants, the Sepoys, are all vegetarians, and are healthy, practically free from syph ilis, and living under excellent hygienic conditions. Examination of 169 Bhutias showed that over 75 per cent. had goitre; nearly 90 per cent. of those over twelve years of age were afflicted. Of 330 Se pays examined, 54 per cent. had goitre. The Bhutias say that their goitres in crease during the rainy season. All the British officers, also, during the preceding rainy season had suffered from enlarged thyroids.