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.tendency, the female sex, and the age of puberty. With 

 regard to its exciting cause, like the poison of malaria, it 

 has never been satisfactorily determined ; but where the 

 disease has arisen without being inherited, the cause can 

 generally be traced to some impurity in the potable water 

 probably some form of iron. In this country women are 

 far more predisposed to bronchocele than men, and although 

 the disease generally occurs about the age of puberty, it 

 may occur from any age up to forty years ; and children have 

 been born with a thyroid enlargement. Just as malaria 

 belongs to marshy grounds, swamps, and jungles, so the 

 causes of bronchocele are intimately associated with moun- 

 tains and valleys, the most common characteristics of the 

 spots in which it prevails being want of due movement 

 in the air, as in deep valleys shut in by mountains. 

 Frequently associated with bronchocele is " that strange and 

 melancholy " form of idiocy or imbecility, called Cretinism ; 

 a condition arising from endemic causes, associated with 

 imperfect development and deformity of the whole body, 

 varying, however, in degree. It is developed under the 

 same conditions as bronchocele ; accordingly it is generally 

 met with in the same localities. In this country it has 

 been observed in the dales between Lancashire and 

 Yorkshire. As in the case of bronchocele, when Cretinism 

 cannot be traced as the result of hereditary predisposition, 

 it will be found to depend upon certain atmospheric and 

 geological conditions, peculiar to special localities. In an 

 endemic disease like bronchocele, where the general health 

 is always in a morbid condition, it seems absurd to associate 

 it only with the enlargement of the thyroid gland, but since 

 it is hereditary, and reveals itself persistently in those 

 families which have once been subject to it, it implies an 



