11 



iu favour cf this way of thinking. Other 

 reasons were of a pathogenic and epi- 

 demiologic order. Regarding the geo- 

 graphical distribution of goitre my expe- 

 rience like that of my informers, was 

 tiiat goitre was constantly seen in tria- 

 fom«— infested regions and unknown in 

 those where the insect is not found. And 

 in the regions where we studied, per- 

 sons, among them children, without any 

 hypertrophy of the thyreoid and living 

 in houses in which there where no tria- 

 tomata where common whilst those li- 

 ving in infested houses all showed goi- 

 tres or hypertrophied thyreoid glands. 

 The high percentage of goitre in the 

 rural huts, even in the ones round the 

 cities and the absence of any lesions on 

 the glands of the towns and villages 

 the people dwelling in good houses, whi- 

 ch do not offer the barbeiro favourable 

 conditions for its proliferation, cannot 

 fail to strike one. The factors usually 

 held to be responsible for endemic goi- 

 tre, among them the drinking-v/ater, 

 were excluded in this case seeing that 

 both the persons who had goitres, chief- 

 ly the children, and the persons who 

 living mider the same conditions, using 

 the same food, had no goitres and lived 

 in houses in which there were no triato- 

 mata. These facts as well as many 

 others which I do not refer to in this 

 work, lead me to consider the goitre 

 as one more element of the disease in 

 trypanosomiasis — regions. And up to 



now no definitive proof to modify our 

 point of view in regarding the goitre asi 

 part of trypanosomiasis in the parts of 

 the country in which this disease is pre- 

 valent. Yet, as we cannot give a positive 

 demonstration for this as we gave 

 for other aspects of the disease in 1916 

 at the time we were synthetising the 

 pathology of the disease, we will con- 

 sider the goitre a question apart, on the 

 subject of which there may exist diver- 

 ging opinions. And on this footing we 

 stand as regards this discussed point. 

 while we await research-u;ork which 

 will displace our way of thinking or 

 will confirm it in a positive way. 



Of late there has been a tendency, 

 v/ith a view to admitting the infectious- 

 ness of goitre, towards attributing the 

 goitre to a filterable virus. And here I 

 must point out that I think it absurd 

 to consider only one etiologic cause 

 of goitre, seen in different parts of the 

 world and having very varied physio- 

 pathological consequences. 



Concerning opinions on the etiolo- 

 gy and pathogenesis of goitre, and spe- 

 cially in trypanosomiasis as its cause 1 

 might give some lengthier arguments 

 based on the epidemiology and geo- 

 graphic distribution and based also on 

 the physio-pathology of endemic goi- 

 tre in the regions in which I studied 

 IL I will, however, return to the subject 

 in later publications. 



