214 THE TREATMENT OF DISEASES. 



Switzerland drink the water which comes from the glaciers, but in only a few of 

 them is goitre prevalent. Then again, as we know, it occurs frequently in Derby- 

 shire, where the snow never lasts long, and even in Sumatra, where snow is never 

 seen. There are reasons for supposing that it is the presence of limestone in the 

 water which produces these injurious effects. In some parts of England Yorkshire, 

 Derbyshire, Nottinghamshire, Hants, and Sussex where the disease prevails, there 

 is a ridge of magnesian limestone running from north to south throughout the entire 

 district. On the other hand, there are many goitreous regions in which the water is 

 not unusually hard. Of late years an attempt has been made and we think unsuc- 

 cessfully to show that the constituent of water which is the actual cause of goitre 

 is some salt of iron, or more rarely of copper. The prevalence of the disease in 

 limestone regions is explained on this theory by supposing that the water has 

 travelled the metalliferous strata of the rocks. 



Goitre may be very rapidly produced. There are certain waters in Switzerland 

 which would cause it even in eight or ten days, and cases have occurred in almost 

 as short a time in other places. It is said that both in France and Italy the drinking 

 of certain waters has been resorted to, and apparently with success, for the purpose 

 of producing goitre, and thereby gaining exemption from military conscription. 



Goitre occurs much more commonly in women than in men, the proportion being 

 about twelve to one. At the same time, it must be remembered that our fashion of 

 dress renders a small bronchocele much more noticeable and less easily concealed in 

 females. It is probable that bad food and low living, by depressing the general 

 health, conduce to the production of goitre. It is met with in all classes of society, 

 but occurs most commonly amongst the very poor, who live in cellars and kitchens, 

 or in damp, ill-ventilated streets and courts. As a rule, the complaint does not show 

 itself in children younger than eight or ten ; but it is occasionally seen in young 

 people shut up in school-rooms or leading a sedentary life as unnatural as it is 

 prejudicial. It is said that the disease is hereditary ; but it must be remembered 

 that in the majority of cases the children are living under identically the same 

 conditions as their parents. Every race of man is liable to bronchocele, and it 

 occurs in all latitudes, from the Arctic regions to the tropics. Franklin found it 

 amongst the inhabitants of the Polar regions, and Mungo Park amongst those of the 

 interior of Africa. 



A goitre may attain a very considerable size, but in many cases it causes merely 

 a slight fulness of the throat, which by many people is thought to be not ungraceful. 

 It may continue for years without reaching any extreme or very troublesome magni- 

 tude. In some cases it has remained stationary for a very considerable time, and 

 has then suddenly, and without any apparent cause, increased rapidly in size. The 

 swelling is usually larger during the menstrual periods, or when from any cause the 

 health is temporarily deranged. Bronchocele is not in itself a painful disorder, 

 nor does it taint the system or affect the constitution in any way. It is, as a rule, 

 a perfectly innocent tumour, and presents no signs of malignancy. Any distress or 

 inconvenience which it may occasion will be from its size, and the pressure it exerts 

 on the windpipe, gullet, and neighbouring structures. Sometimes it obstructs the 

 return of blood from the head, and gives rise to headache, giddiness, noises in the 



