Goitre

“ 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. ”

“ Time is required for effecting a cure. This varies according to the age and size of the goitre. Three months may suffice for a small goitre of one year's growth. Six months may be required for one twice as large and of longer standing. A year and a half is the longest period during which I have had to continue the medicine. But during all that time the goitre was manifestly diminishing.
The dose is a teaspoonful of the tincture twice or three times daily, in a well-developed case. Half a teaspoonful twice a day will answer in recent cases. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ It is very common in some places, chiefly in the mountainous or hilly districts of Derbyshire, Devonshire and Wales. It is more common in the valleys than in the hills. It is supposed to be due to some constituent in the water, possibly excess of lime. Goître, however, is not very infrequent in persons who have never seen a mountain, and who have lived in districts which are decidedly not goîtrous. There are many forms of goître, and the treatment for each variety is different. ”

“ 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. ”

“ 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. ”

“ The latter is the feature of only the severest types, when there is an associated goitre, the combination designated as exopthalmic goitre.
There are, too, individuals in whom hyperthyroidism and hypothyroidism are mixed, or rather alternate. At one time they present the phenomena of the one, at another of the other. They are the people who complain of the cyclic quality of their moods and purposes. Their mood will be a heaven of exaltation and exhilaration, and then descend into a slough of despond from which they feel themselves inextricable. ”

“ 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. ”

“ This is especially important in localities in which goitre is enzootic, and embraces careful attention to the general health, the avoidance of overwork, exhaustion, indoor life, lack of exercise, impure air, faulty feeding, starvation, and water from the goitrous soils. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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 ”

“ A non-inflammatory enlargement of the thyroid gland, independent of known microbes or parasitism.
Causes. Goitre is an endemic disorder in man and beast, though it may occur sporadically during or after a debilitating disease, or in animals that are overworked or out of condition. As occurring endemically all accessory factors that undermine the general health must be admitted as potent factors, though insufficient of themselves to develop the malady in the absence of 561the specific cause. ”

“ Most of the women seem to be troubled with goitres, and we observed that all who have them wear rows of garnets strung tight on the part affected, whether with the idea of hiding the deformity, or of rendering the beauty of the swelling more conspicuous, or of charming it away, I cannot tell. ”

“ 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. ”

“ 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. ”

“ A surgeon also, whom I met at the baths of Louesch, informed me that he had frequently extracted from different goitres small pieces of tuf, which is also found in the stomachs of cows, and the dogs of this country are also subject to this malady. This gentleman added, that, to complete the cure of young persons attacked by this complaint, he either removed them from waters impregnated with tuf, or recommended them to drink only of water that had been purified. The children of goitrous parents are often born with these swellings ”

“ Every bench was a church chair, all was peaceful and holy, and the firmament above an infinite church dome.
In many a village and in many a house a true Eden may be hid, which has neither been named nor marked down; for joy is fond of covering over and concealing her tenderest flowers. Gottreich reposed in such a fulness of bliss and love, of poetry and religion, of springtime, of the past and of the future, that he feared in the bottom of his heart to speak his happiness out, save in prayer. In prayer, thought he, man may say all, his happiness and his misery. ”

“ 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. ”

“ 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. ”

“ LVI Then as the spoil taken from one and another 283 of the neighboring tribes diminished, the Goths began to lack food and clothing, and peace became distasteful to men for whom war had long furnished the necessaries of life. So all the Goths approached their king Thiudimer and, with great outcry, begged him to lead forth his army in whatsoever direction he might wish. He summoned his brother and, after casting lots, bade him go into the country of Italy, where at this time Glycerius ruled as emperor, saying that he himself as the mightier would go to the east against a mightier empire. ”

“ 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." ”

“ Goetz: They have ceased firing, and offer a truce with all sorts of signs and white rags. They will probably ask me to surrender on knightly parole.
Lerse: I'll go and see. 'Tis best to know their mind.
[Goes out and returns shortly.
Lerse: Liberty! Liberty! Here are the conditions. You may withdraw with arms, horses, and armour, leaving all provisions behind. Your property will be carefully guarded. I am to remain.
Goetz: Come, take the best arms with you, and leave the others here! Come, Elizabeth! Through this very gate I led you as a young bride. Who knows when we [Pg 12] shall return? ”

“ The lady Abbess hastened to the convent, rang the chapel-bell, when all the pious sisterhood hurried from their cells, fell upon their bare knees, chastizing themselves, and praying to heaven for mercy towards the old General. The burgomaster threw himself upon his horse, and trotted back to the town to impart the terrible news to his wife, children and domestics. Gothard, who was a courageous knight, alone remained, absorbed in gloomy reflection, leaning against the wall, with his eyes fixed on the darkness beneath. ”

“ The Goths are under him an independent people under a national king; their independence is in no way interfered with if the Gothic king, in a moment of peace, accepts the office and titles of a Roman general. But under Alaric the Goths make no lasting settlement. In the long tale of intrigue and warfare between the Goths and the two imperial courts which fills up this whole time, cessions of territory are offered to the Goths, provinces are occupied by them, but as yet they do not take root anywhere; no Western land as yet becomes Gothia. ”