392 Fortieth Annual Meeting 



disease was more prevalent in hard water than soft water, for instance. 

 One of my own family got a thyroid tumor from drinking water from 

 a spring in West Virginia, and the same summer the water of another 

 spring gave a thyroid tumor to a lady, wife of one of the judges in 

 the district. I am not a medical man but I want to know if you have 

 gone into the qualities of the water. This water I have referred to 

 did in both instances contain trout. 



Mr. Marsh : We have analyses of a large number of fish-cultural 

 waters. The disease is widespread among nearly all these waters. 

 They are mostly spring waters and we have nothing to compare them 

 with. We have gone into the subject and can find nothing that you can 

 correlate with the development of tumors. There is no chemical evi- 

 dence so far with respect to the dissolved substances in the water 

 which shows anything whatever as far as I know. 



Dr. W. p. Herrick, New York City : On the point of thyroid tumor 

 and its connection with water, in the human race it is well known that 

 thyroid enlargement is most prevalent where the inhabitants drink 

 melted snow water, as in Switzerland. 



Mr. Titcomb : That would be strictly soft water. 



Dr. Herrick : There is some cause, but we do not know what it is. 



Mr. Marsh : I know that snow water used to be ascribed as a 

 cause of goiter. I understand that goiter is known to be often water- 

 borne and traced to wells, not necessarily snow water; but what it is 

 in the water which causes the disease no one has declared, I think. 

 Boiling corrects that water, however, I understand. Now I see Dr. 

 Levin is here and he very likely can tell us something in particular 

 about goiter in relation to water. 



Dr. Isaac Levin, New York City: We do not know much more 

 about the relationship between water and human goiter than what we 

 know about the relationship between water and goiter in fish. It is a 

 subject of which the proof is purely statistical. There is no pathological 

 proof of the relationship between water and goiter; and whether there 

 is an actual relationship is just as little known as the relationship be- 

 tween water and cancer to which you referred in your paper. It is 

 also purely statistical, and this statistical evidence in medical matters, 

 in matters of pathology, is not always of such a character that we can 

 draw conclusions from it. We are not at all certain as yet that there 

 is a real direct relation between the causation of goiter and water. So 

 much the less do we know what there is in the water that is causing it. 



