Iron is present in the water only in very minute quantities. As to lime as a cause, it appears that many of the Bhutias without goitres are great lime eaters, while of the Sepoys, who never touch it, over 50 per cent. had developed goitres within twenty months after ar rival. The theory that the disease is due to carrying heavy loads up and down hills might satisfy in the case of the Bhutias, but not in that of the Sepoys, who, though not carriers, yet have goitre. Fifty-five per cent. of children under twelve had no goitres after living there always, or about the same percent age as did develop them among the Se poys after a visit of only twenty months. E. E. Waters (Brit. Med. Jour., Sept. 11, '97).
The modern view of goitre is that it is caused by a contagiuns vivuns, limited to certain areas for some unknown reason, existing in the soil and reaching man by drinking-water or unclean hands. The writer adds that the organism when introduced into the body induces an in creased demand for thyroid secretion, which the gland hypertrophies to supply. The proofs are: 1. The gland enlarge ment is accompanied by no constitutional disturbance. 2. The microscopical ap pearances of the primary changes are those of a gland hypertrophied and act ive. 3. Treatment by thyroid is fol lowed by reduction in size of the gland, which stops if the remedy is stopped. 4. The successful removal of a goitre by iodine treatment has been followed by symptoms due to deprival of increase in gland-secretion.
Sporadic goitre may also be explained in a similar manner. Daniel McKenzie (Glasgow Med. Jo-ur., Jan., '99).
More recently, Blebs, Kocher, Waters, and others have attempted to find a microbic causation for the disease. Thus, Kocher points out that goitre-water dif fers from free water in containing many more micro-organisms. And Waters contends that there may be micro-organ isms of the amoeba type resembling the malarial organisms with a selective power for the thyroid and its secretions.
Tavel, working for the Swiss Commit tee of Twenty-five Physicians, and com paring waters which were found to in duce goitre with goitre-free waters, found that, while both were, upon chem ical analysis, pure, the former contained numerous microbes. One form common to two goitrous waters inoculated into guinea-pigs resulted in the hypertrophy of the thyroid, but the same form had no effect upon dogs. Attractive as this theory may seem, however, in the ab sence of any other satisfactory explana tion, two facts seem to be strongly op posed to it: 1. That goitre affects females so
greatly in excess of males.
2. That the disease, at least in its early stages, may be arrested and, in deed, cured by the removal of the patient from a goitrous to a goitrous-free district.
If microbes play any part in inducing goitre it would seem from these consider ations that they do not directly infect the organism, but by their products of growth, contained in the water in which they grow, they must induce a form of intoxication capable of affecting the female rather than the male. It will be seen that the whole subject of etiology is thus still in a very vague state.
The drinking-water carries the harm ful agent. "Goitre-water differs from goitre-free water in containing many more micro-organisms." Theodor Kocher (Wiener med. Woeb., Aug. 15, '91).
Case of thyroiditis of spontaneous de velopment. The gland was not enlarged prior to the attack, although it had for merly been considerably hypertrophied. Bacteriological examination of the pus, withdrawn under strict antiseptic pre cautions, revealed the presence of pneu mococci. It is the first case of the kind on record. Ge'rard-Marehand (Le Bull. Me'd., June 21, '91).
Cases of metastatic thyroiditis operated on by Kummer and examined bacterio logically by Tavel. In the first the goi tre had existed for fourteen years. The patient was attacked with diarrhoea and fever; two days later, severe pains in right side of neck. The thyroid became inflamed and respiration was impeded. Eight half of the thyroid removed, which was found to contain two cysts,—one colloid, the other inflamed. The latter was found to contain the typhoid bacil lus (of Ebert]]). This established the nature of the original disease. The sec ond case was one of post-puerperal thy roiditis. In the pus were numerous strep tococci which had, doubtless, invaded the organism at the time of labor. Both cases recovered. Nicaise (La Semaine M'ed., May 27, '91).
Case of a young man who had a goitre which had given him very little trouble. After an attack of typhoid fever an abscess formed in the gland, which was opened aseptically. A microscopical ex amination and a culture showed the presence of the typhoid bacillus in a pure state. F. Colzi (La Semaine Aug. 19, '91).