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Diseases Connected with the Thyroid Gland

water, lime, disease, carbonate, iodine and neck

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Goitre (Bronchocele, Derbyshire Neck) is the chief disease of the thyroid gland (p. 281). It consists of an enlargment of the gland, some times a uniform enlargment of all its substance, sometimes an excessive growth of some part of its ordinary structure. The amount of enlarge ment varies from a mere extra fulness in the front of the neck to an enormous growth hanging clown over the chest. It is commoner in females than in males, and occurs rather between the ages of eight and twenty. It is a disease which may be found anywhere, but is endemic, that is, common among the people living in a certain district. Thus in England it is common in Derbyshire, and is hence called Derbyshire neck. In Yorkshire, Hampshire, Sussex, and Nottinghamshire, in the Swiss valleys, among the Alps, Himalayas, Andes, and in the Green Mountain region of Vermont in America it is also common. Its frequent occurrence in such districts is ascribed to some malarious tendency, and specially to the nature of the drinking water. An excess of lime salts in the water, particularly carbonate of lime, is held to be the chief cause of its production. People coming into a goitrous district, who stay in it for a sufficient length of time, are liable to be affected, while children of people who have the disease, and who are removed from the place, cease to be liable. The disease is not, therefore, heredi tary, but peculiar to the locality.

Its symptoms are those of a tumour situ ated in the lower part of the front of the neck, in front of the windpipe. The tumour goes on enlarging, usually without pain. Any other symptoms are such as would naturally result from the presence in that region of a tumour of any size, symptoms due to pressure. The pres sure on the windpipe may obstruct the passage of air by compressing the tube. The gullet be hind may be compressed. Veins may he pressed upon, and nerves. The danger of compressing nerves is specially great, since the nerves pro ceeding to the windpipe are liable to be in volved, and the irritation produced may lead to spasmodic closure of the windpipe and sudden suffocation, or suffocation may arise from gra dual closure of the tube by the gradual com pression. Even when the tumour is of moderate

size, headaches, some difficulty of breathing, and tendency to congestion in the hmi are signs of the pressure produced by it, first thing to be done is to have the patient removed, if possible, from the goitrous district to the sea-coast. If this be impossible, at least efforts may be made to diminish the tendency to goitre by purifying the drinking water, which seems to be the chief agent in the disease. If it contain excess of carbonate of lime, this may be got rid of by boil ing the water. Carbonic acid is driven off, and the lime in combination with it falls to the bottom, so that the clear water may be decanted off. Shaking it up with air will render it palatable for drinking. Clark's process for ridding water of excess of carbonate of lime consists in adding lime to the water. This unites with the excess of carbonic acid in the water to form carbonate of lime, which falls to the bottom along with the carbonate previously held in solution in the water. The water may also be purified from salts by distillation. But this process removes all the salts from the water, and makes it very tasteless, which is not desir able.

As regards medicines for the treatment of goitre, the chief is iodine, given as iodide of potassium in doses of 2 to 20 grains according to age and the way in which it is tolerated by the patient. It should be given twice or thrice daily, simply dissolved in water. Along with it there may be conjoined the use of iodine liniment painted over the enlarged gland occa sionally, but not often enough to irritate the skin.

The treatment by "burnt sponge" is the same as that by iodine. It seems to be the iodine in the "burnt sponge" that is the effi cient ingredient.

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