454 NELSON W. JANNEY 



McCarrison (d), have produced goiter experimentally in animals and 

 man throug^ drinking goitrigenous water or from the residue of such 

 water on a Berkefeld filter. After such filtration, goiter still can be pro- 

 duced, so Wilms, who developed the so-called "organic theory of goiter" 

 concludes the toxic agent must he a toxin or toxalbumin or organic ferment 

 from organic substance, especially as boiling or heating over 70 destroys 

 its toxicity (E. Bircher, Wilms, Breitner, Lobenhoffe*, McCarrison). 

 Dialysis removes the goitrigenous agent from water, the substance collects 

 upon the membrane of the dialyser and centrifugalization renders the 

 water innocuous. 



The Theory of Direct Contagion has been advocated by A. Kutschera, 

 L. Taussig among others. Kutschera (b) bases his views upon the strong 

 familial, house, or locality tendency of the disease, stating that it is only 

 present where there has been opportunity for direct personal contact. 

 This author denies that the disease is so closely bound to the water supply of 

 certain coninmiunities as has become firmly fixed in the minds of laymen 

 and physicians but rather depends upon transmission through bedding, 

 clothing, etc. He cites instances, as does McCarrison, of a spread of the dis- 

 ease from the introduction of a goitrous individual or cretin into an unaf- 

 fected community. As an important example of the house mode of infec- 

 tion is quoted the description of Fradeneck in lcS44 of the endemic cretin- 

 ism in the Tostenhuben community dwellings of Sirnitz, Carinthia. At the 

 time of this description, practically all who lived in these dwellings were 

 cretinous. Later the buildings w r ere partly rebuilt after a fire in 1847 

 and partly refinished. After these occurrences, goiter and cretinism 

 disappeared. The water supply remained the same throughout. Kuts- 

 chera correctly concludes from this and many other examples that the dis- 

 ease is communicated by personal contact. He cites the parasitic thy- 

 roiditis described by Chagas in Brazil which is caused by a trypanosome, 

 schizotrypanum cruzi, and transmitted by a biting insect. The chronic 

 forms of this disease are characterized by goiter although some doubt 

 of the accuracy of Chagas' observations in this regard is expressed by Mc- 

 Carrison. Taussig (who supports the contagion by contact theory) com- 

 pares the endemicity of the cretinic degeneration in Bosnia to that of 

 leprosy and syphilis which have been proven contact diseases in the same 

 country where his studies were carried out. In this Austrian province 

 all three diseases are especially prevalent among the rural Mohammedan 

 population who cling to a primitive manner of life, families sleeping hud- 

 dled on the floor of the same room, eating and drinking from the same pot 

 without separate utensils. To the truth of these statements the writer 

 of this article can also testify. On a visit to the interior of Bosnia, he 

 was astonished at the filthy mode of life. Taussig quotes many examples 

 of garrisons and other hygienic dwellings in this country where in spite 

 of the same water supply and much goiter being generally present the 



