GOITER 155 



(for example, in Baden and Thuringen). Persons who come from a nongoi- 

 ter neighborhood into a goiter neighborhood often develop goiter, or become 

 affected with it after their return. E. Bircher here cites an instructive ex- 

 ample. A family in a nongoiter neighborhood had healthy children. When 

 they came into a goiter district, the parents themselves remained non- 

 goitrous but had a cretin for a child. Kocher reports another example: The 

 parents were healthy, and as long as they lived in a goiter-fr^e district had 

 nine healthy children. When they came into a goiter district, they had three 

 cretin children, of which the first was the most pronouncedly affected. 

 Again the thirteenth child was normal, but very small. Breitner has recently 

 published a similarly instructive case. Enormous outbreaks of goiter have 

 been often observed in regiments after their stationing in goiter districts. 

 Families that remove from goiter districts can soon lose their goiters. Also 

 the occurrence of goiters is not rarely observed in animals, after their trans- 

 ference to a goiter district. 



The noxus of goiter is bound in the drinking water. In the goiter terri- 

 tories there exist indeed especial goiter brooks; there are numerous examples 

 in the literature of goiter communities becoming free of goiter after they 

 had established drinking-water conduits from goiter-free vicinities. 



The occurrence of the goiter noxus in the water is bound together with a definite 

 geological structure of the soil. This view has been especially promulgated by Bircher, 

 Jr., on the ground of his penetrating studies and excellent observations. According to 

 Bircher, cretinic degeneration is found only upon the marine deposits of the paleozoic 

 ages, the dryassic, and the tertiary ages, while the eruptive formations, the Jurassic and 

 fresh-water deposits, are free from the noxus. This view is not generally shared, but is, 

 however, set upon a working basis by the works of Johannesen, and latterly by Bircher, 

 Jr., and Lobenhofer. The practical significance of the investigations of Bircher, Sr., 

 is seen at its best in that the community Rupperswill has become goiter-free since it 

 has led its water from springs lying in Jurassic deposits. A like example is furnished by 

 the village Asp. 



Previously healthy animals may become goitrous on having goiter water 



furnished to them. The noxus goiter goes through a Berkefeld filter; it is 



destroyed by temperature higher than 7oC. (E. Bircher). Therefore it is 



'likely, as Wilms first assumed, that the noxus is not a miasma, but a toxin or 



toxalbumin from an organic substance. 



It does not dialyze, therefore behaving like a colloidal emulsion. The 

 struma produced shows histologically changes that are degenerative, and on 

 the use of weaker goiter water, also hyperplastic. The animals developed 

 cardiac hypertrophy, and many remained behind in growth. 



i. Goiter 



We understand by this term a noninflammatory, diseased alteration of the 

 thyroid, mostly associated with enlargement of this gland, while the thyroid in 



