Goiter

“ Goiter is endemic in some countries, particularly in Switzerland and Austria, and appears particularly at the age of childhood or of puberty. Some communities in this country using water containing an excess of calcium salt show distinct evidences of endemic goiter. Extirpation of the thyroid gland has in recent years been successfully practiced. Warren has extirpated one lobe of the thyroid after preliminary ligation of the common carotid on the same side. Green practiced rapid removal of the tumor and ligated the bleeding vessels later. ”

“ A goiter may consist of (1) simple enlargement of the follicles which are filled with albuminous matter (follicular goiter) ; (2) an increase of connective tissues between the follicles, causing the swelling to be dense and resistant (fibrous goiter) ; (3) a great increase in size of one or more follicles, forming a cyst (cystic goiter) ; (4) great dilatation of [Pg 311] the blood vessels in the gland accompanied with pulsation with each heart beat (vascular goiter) . ”

“ Symptoms.—Enlargement of the Thyroid bodies of the ductless gland situated on the under surface of the neck. It may vary from the size of a pigeon’s egg to the size of a man’s two fists. It is very easily detected, and does not often interfere with the animal’s breathing unless it becomes abnormally large and causes pressure on the windpipe, jugular vein and esophagus. A dog affected with Goiter does not thrive, his hair looks faded, dusty and rough. ”

“ In the western Gobi, the Prjevalski gazelle (Gazella prjevalski) is more abundant than the other species, but it never reaches the region which we visited.
The goitered antelope is seldom found on the rolling - 128 - meadowlands between Kalgan and Panj-kiang on the south, or between Turin and Urga on the north, according to our observations; they keep almost entirely to the Gobi Desert between Panj-kiang and Turin, and we often saw them among the "nigger heads" or tussocks in the most arid parts. ”

“ To be a "thickneck" is no bar to marriage on either side. The goitrous intermarry, and have children who are goitrous, or, rather, who will, if exposed to the same conditions as their parents, inevitably develop goitre. Frequently the disease is intensified in the offspring into cretinism, and I can conceive of no sight more disgusting than that which so often met our view, of a goitrous mother suckling her imbecile child. On one afternoon, among those who passed us on the road, I counted eighty persons with the deformity. ”

“ Fully 80 per cent. of the cases occur in Indian women, the disease being not only much less frequent, but also less decided and less extensive in the male. The average age of onset of the disease was from 12 to 14 years. There are many instances illustrating the apparent heredity of goitre. Several consecutive generations show its development. Only one case is reported in which goitre was associated with cretinism. Goitre among Indians cannot be traced to high altitudes, climate or water containing excess of calcium magnesium salts. ”

“ The inhabitants of this district are afflicted with goitre in its most distressing forms; and the Swedish doctor told us he believed that about fifty per cent of the population were victims of the complaint, which in his opinion was not the same as the European goitre, and for which he knew of no remedy save iodine. One theory is that it is due to the habit of drinking stagnant water stored in tanks, the river unfortunately being at some distance from the city; but the peasantry living right out in the country are by no means exempt from the scourge. ”

“ Goitre, not too vascular in character, is removed by a longitudinal incision over the tumor, after which the gland is to be dragged out, with its entire capsule, by means of a blunt hook. A large goitre in a feeble patient, however, is better left alone, as it is difficult to remove all the intricate roots of the tumor, and if any portion is left it is prone to return. In such cases Gilbert says we shrink from the application of the actual cautery, for fear of injury to the surrounding vessels and nerves. ”

“ Nought but death has the right to sever us, but Gotar means to steal thee away, seeking thy love by robbery. When he has committed the theft, pretend it is done with thy goodwill; yet put off the wedding till he has given me his daughter in thy place. When she has been granted, Gotar and I will hold our marriage on the same day. And take care that thou prepare rooms for our banqueting which have a common party-wall, yet are separate: lest perchance, if I were before thine eyes, thou shouldst ruffle the king with thy lukewarm looks at him. ”

“ A throbbing is felt throughout the body, and many of the larger blood-vessels are, like the heart, seen to pulsate strongly. The enlargement of the thyroid is gradual, and rarely increases to any great size, thus differing from the commoner form of goitre. The enlarged gland is of soft consistence, and communicates a thrill to the touch from its dilated and pulsating blood-vessels. Accompanying the goitre a remarkable change is observed in the eyes, which attract attention by their prominence, and by the startled expression thus given to the countenance. ”

“ In treating goitre by zone therapy a thin probe, (See Fig. 9) , the point of which is wrapped in cotton dipped in a little alcohol, spirits of camphor or camphor water (these seem to increase the “impulse”) is passed through the nostrils to the posterior or back wall of the pharynx. Pressure is made in various spots “low down” on this wall (a little practice will soon determine almost the exact “spot” to probe) , until a definite sensation is felt in the region of the goitre. ”

“ Sven Hedin says that three-fourths of the population of Yarkand are suffering from goitre; he ascribes the prevalence of the disease to the bad quality of the water, which is kept in large basins, used indifferently for bathing, washing, or draining. Only Hindu and “Andijdanlik” merchants, who drink well water, are free from goitre.
Lieutenant Roborovsky, the companion of Pievtsov, in 1889, says: “In the streets one meets many men and women with large goitres, a malady attributed to the bad quality of the water running in the town conduits, and drunk by the inhabitants in its natural state. ”

“ The type of the "Complaisant Mother" is marvellously rendered by Goya, who, like all the Spanish painters, possesses a ready and profound sense of the ignoble. It is impossible to fancy anything more grotesquely horrible, more viciously deformed. Each of these frightful old shrews unites in her own person the ugliness of the seven capital sins; compared to them, the Prince of Darkness himself is pretty. Just fancy whole ditches and counterscarps of wrinkles; eyes like live coals that have been extinguished in blood; noses like the neck of an alembic, covered with warts and other excrescences ”

“ A man with a gong always headed the way; there was a driver to every five animals. In the sandy bed of the river at one place a caravan was resting. Their packs were piled in parallel rows; their horses browsed on the hillside. I counted 107 horses in this one caravan. [Pg 227]
The prevailing pathological feature of the Chinese of Western Yunnan is the deformity goitre. It may safely be asserted that it is as common in many districts as are the marks of small-pox. Goitre occurs widely in Annam, Siam, Upper Burma, the Shan States, and in Western China as far as the frontier of Thibet. ”

“ Goitre is very much more general than is usually supposed in France. In Asia, it is to be found amongst the inhabitants of Chinese Tartary, Thibet, and Ceylon, and in India amongst the dwellers in the valleys and extensive plains that lie at the foot of the Himalayan mountains. ”

“ We were surprised to see in these fertile plains how prevalent goitre is amongst the women. In the drive from Moentilan to the Boro Budur, at least one in twenty were so afflicted. We commented on this fact to a native official while waiting for our tram at Moentilan, and he assured us that it is remarkably prevalent amongst the common people, but that the men do not suffer in the same proportion as the women. ”

“ If waters impregnated with tuf, or certain calcareous substances, produce the Goitres, it will follow, that in every place where they abound, the inhabitants should drink of waters so impregnated, which seems consonant to the truth of the fact." The same causes which occasion the Goitres, have probably a considerable operation in producing the number of idiots, as they are always in most abundance where the Goitres prevail. ”

“ Gotar listened attentively to this from a distance, and then said, as loudly as he could: "Each man fights for valour according as he remembers kindness." Erik said to him: "I have requited thy kindness by giving thee back counsel." By this speech he meant that his excellent advice was worth more than all manner of gifts. And, in order to show that Gotar was ungrateful for the counsel he had received, he said: "When thou desiredst to take my life and my wife, thou didst mar the look of thy fair example. Only the sword has the right to decide between us." ”

“ Occasionally the enlargement is uniform, but more commonly one of the lobes, generally the right, is the larger. In rare instances the disease is limited to the isthmus which connects the two lobes of the gland. The growth is unattended with pain, and is not inconsistent with good health.
Goitre is a marked example of an endemic disease. ”

“ While Goutran was thus impatiently questioning the man, a carriage stopped, from which descended Fanfar, Sanselme, Coucon and Madame Caraman.
"Ah! Monsieur Goutran!" exclaimed Fanfar, "I have just been to your rooms, and am thankful to meet you here. I am anxious to consult with you."
"You know, then, what is going on?" cried Goutran.
"I think I do; but let us go up-stairs; before we begin the fray, it is well to understand the battlefield, and to become familiar with it." ”

“ Many attempts have been made to account for the growth of the goitre, but it is yet unexplained. The men are not so subject to it as the women, though among them, even, it is frightfully common. But how account for the continual production by ordinary parents of this brute race of cretins? They all look alike, dwarfish, large-mouthed, grinning, and of hideous features and expression. It is said that the children of strangers, born in the valley, are very likely to be idiots, resembling the cretin exactly. ”

“ When the Goitres become large, they produce a difficulty of breathing, and render the person so affected, extremely indolent and languid. These idiots are treated with great regard by the rest of the inhabitants of the country, who even consider them, in some degree, peculiarly favoured by Providence—thinking that they are certain of eternal happiness, as not being capable of forming any criminal intentions. ”

“ Elizabeth, his wife, is busy in attending to the needs of a wounded man; the men are all on the ramparts, and so the women and children are hurrying here and there, moulding bullets or preparing food for the besieged. Old Goetz has just entered. His rude physiognomy, frank and warlike, shows the stubbornness and bravery of this man of iron; armed with his breastplate, he has placed, for an instant, his casque and his arquebuse on a massive oak table, on which is stretched out the half of a deer, that no one has had the time to cut up. ”

“ She is in the flower of her youth, her beauty, her desires—”
“Be silent, mother of two left feet,and bring me my pipe.”
“I will not be silent, and I will not bring thee thy pipe—no—by the crimson pig's bristles!” Her voice leaped up shrilly. “Thou hast no heart, no pity, no understanding of youth, I tell thee, Gouthia must marry—”
MUST? But whom? Who shall be the father of her sons? There is not her equal in blood in Kairouan nor in all the countryside. She is a Shareef. She is of the lineage. Fool!”
The old negress stood her ground, firmly, bravely. ”

“ The people seem a sturdy, solid race, but through the greater part of the province which we have traversed, and especially round the capital, they are greatly disfigured by goitre. Every day we see scores of people (even quite young children) suffering from this disease. The women do a large share of all the hard work, carrying heavy loads, despite their small feet; the loads are fastened on by broad bands passed round the forehead, like those of Newhaven fishwives. These bands are frequently run through holes in a big wooden collar worn both by men and women. ”

“ As night came on, Gouthia hardly listened. She loved her father. Her loyalty to him was of that unflinching quality that generations of the women of her race had rendered to the men of her clan. Her father could do no wrong. But she was so pitifully young, and often, as now, she felt lonely, and out there beyond the garden walls was life. But being an Oriental girl, an Arab, veiled and sheltered, she only knew that this woman-veil was all about her, in sodden, stifling folds, that weighed upon her life, her heart her brain and body. ”

“ The natives strongly assert that the climate is unhealthy for strangers, and we all suffered more or less from intractable diarrhœa. Smallpox, too, was prevalent; and one of our collectors and a Kakhyen sub-chief, who had accompanied us, died from it. We were strongly cautioned against the use of the river water, to which the natives attribute the prevalence of goitre, which is most unpleasantly remarkable among men and [Pg 207] women and children, some goitres being so large as to require special support ”