Goitre. Bronchocele. Eyilargement of the Thyroid. 561 



the specific cause. Thus iu Europe women suffer more than 

 man, being more confined ijidoors and being less muscular and 

 vigorous. In New York the new born offspring of ewes, kept in 

 close confinement during winter, may be all goitrous, while those 

 of flocks, ha\'ing a free run through the whole season, escape. 

 Gurlt has seen the same in goats. Apart from debilitating 

 diseases New York horses and cattle develop the greater number 

 of cases in winter, the period of confinement and idleness. 

 House dogs suffer more than hounds. 



Poor diet has a similar effect. In Europe where the di.sea.se is 

 very prevalent in the underfed peasant population, it is rare among 

 the highly fed domestic animals. Bouley says it is excessively 

 rare in animals even in the localities in which it prevails in man, 

 and though mentioned by Eydtin, Johne, Haubner and others it 

 is not as a common affection. In New York and Pennsylvania 

 on the other hand it is rare in the well-fed human population, 

 and very common in horses, mules, cattle, sheep, swine and dogs. 

 I have known congenital goitre to prove fatal to a new-born 

 dromedary in Central Park, New York. The long, severe win- 

 ter, close confinement, and impure air, doubtless as nuich as the 

 spare diet contribute to tliis prevalence among the animals in New 

 York. 



Intestinal zvorms and other parasitisms must be accepted as 

 secondary factors, the development of goitre often going on sim- 

 ultaneou.sly with the increase of the parasites. 



Heredity is claimed as a cause by Moller and others, and doubt- 

 less a weak constitution transmitted from parent to off.spring, is 

 more susceptible. Apart from this the exposure of both to a 

 common specific cause is the main factor in its production. 



Locality. This must be accorded a first position in the causa- 

 tion of goitre, so far at least as it occurs endemically and enzootic- 

 ally. In England it has prevailed, in man, on the limestone hills 

 of Derbyshire, and Gloucester (Cotswold) ; in Europe it is com- 

 mon in the Alps, Pyrenees, Savoy, vStyria, Silesia, in the Black 

 Forest and in the Rhone valle}' ; in Asia it prevails in the Hima- 

 layas, the Altai Mountains, the hills of China, and in the Pun- 

 jaub ; in South America it is seen in the valley of theOronoco ; in 

 North America in Saskatchewan, Ontario, Michigan, Ohio, Penn- 

 sylvania, New York, Vermont, Virginia and Alabama. A large 

 36 



