On the Causes of Goittre. 339 
Arr. XVIII—On the cause of Goitre.—Felix qui potuit 
rerum cognoscere causas. 
iTTsBURGH, Dec. 21, 1821. 
To Proressor Siuuman, 
Sir—You know that the inhabitants of this place have 
been from its earliest settlement, subject to the Goitre :-— 
The greater part of philosophers have very properly, sought 
to trace this complaint to the influence of local and natu- 
ral causes ; but prevailing as it does in countries so widely 
different in their geological and mineral features, there is 
always some circumstance irreconcilable with all their theo- 
ries on the subject. 
That indefatigable naturalist, the late Dr. Barton, attri- 
buted Goitre to a miasm of the same species as that which 
produces intermittent fevers, and assumes the faet that the 
scite of Pittsburgh is low and confined, somewhat in the 
form of a basin, the atmosphere of which in summer be- 
comes heated and stagnant. This description is true to that 
extent ; the scite of the town is low in comparison with the 
adjacent hills but high enough from the water, which is 
pure and salubrious, for every object of health, and it is 
freely ventilated by the constant breeze through the river 
valleys. There is no doubt however, that there are many 
Situations in the south west regions of this country where 
this miasm exists under every possible condition, where 
Goitre is unknown. 
Dr. Barton refers also to this place in confirmation of 
the doctrine of Mr. De Saussure, that “ the cause of the 
complaint is to be sought for in some modification and con- 
dition which is exclusively confined to valleys but little ele- 
vated above the level of the sea ; this modification is a hea- 
ted and stagnated air, owing to the confined situation of the 
valley.” It so happens unluckily for this opinion of Mr. 
De Saussure, that Goitre prevails on the prairies of Michi- 
gan, onthe German flats in New York, and upon the spa- 
cious and open plains of Mexico, in the latter case at an el- 
evation of six or seven thousand feet above the ocean ; and 
is unknown in the little coves among the mountains of this 
State, which in some instances resemble amphi-theatres, and 
are exceedingly hot in summer. 
