470 KELSON W. JAKKEY 



tributed among 8 per cent adults and 5 per cent school children. Lower 

 village 38 per cent goiter among 20 per cent adults and 66 per cent school 

 children. For other instances, see section Etiology. 



Treatment of Goiter. The preventive treatment includes a general 

 observance of personal hygiene, a proper diet, and wholesome mental sur- 

 roundings. In view of recent experimental work connecting endemic 

 goiter with an infected water supply and bacterial absorption from the 

 intestine, it is likely that the same etiological factors may play a role in 

 sporadically occurring thyroid hypertrophies. Therefore, pure water, 

 pure food and proper care of gastro-intestinal diseases, especially chronic 

 intestinal stasis and colitis, be they present, should be included in the 

 prophylaxis against goiter. 



The avoidance of tight neck-bands and occupations requiring stooping, 

 therefore congestion of head and neck, is recommended. 



The influence of the use of sea-salt in the prophylaxis of goiter has 

 been emphasized by L. Taussig et al., who comments upon the freedom of 

 the disease among seacoast dwellers and other communities in which sea 

 salt is used extensively. It is suggested that such means of prevention be 

 employed in goitrous communities. The therapeutic action depends not 

 upon the sodium chloric! but rather upon the small amounts of iodin 

 originating from pelagic flora. It may be recalled that goiter and cretin- 

 ism among animals has been likewise prevented and benefited. 



Recently the prevention of goiter on a large scale in the schools has 

 been accomplished by (). P. Kimball and D. Marine (&) through small 

 doses of iodin preparations (0.2 to 0.4 gm. sodium iodid daily). The 

 results may be quoted as follows : 



"Xot a single pupil in whom the thyroid was normal last year and 

 who took iodin, showed any enlargement, while of those not taking iodin, 

 '2i\ per cent showed definitely enlarged thyroids some moderately large 

 goiters. Even more than a prophylactic action is shown in the results 

 just one-third of the goiters marked "small goiters" disappeared; and one- 

 third of those marked "moderate goiters" showed a decrease of 2 cm. or 

 more. Accordingly a distinct therapeutic effect is clearly demonstrated." 



Iodin has been known for centuries in the treatment of goiter. It 

 may be used externally as the tincture or in an ointment and is often 

 very effective in small, recent, or congested hypertrophic glands. Usually, 

 however, internal treatment is required. Dock recommends 0.1 to 0.2 

 gin. C 1.5 to ,'5 or.) of i ()( li n ( ] a iiy j n t ] le f orm o f Lugol's solution. It is 

 probable that iodin thus administered stimulates the thyroid to increase 

 its hormone output by supplying increased amounts of the chief element of 

 thyroxin (containing <>5 per cent iodin, Kendall), the active constituent 

 of the gland. This would explain the good results obtained by the use of' 



