ENDEMIC GOITRE 



1921 



lives in earth and passes via potable water to man, in whose ali- 

 mentary canal it passes a parasitic existence. The nature of this 

 contagium vivum is unknown, but McCarrison is inclined to suspect 

 an amoeba. Chagas has shown that goitre is a part of the syndrome 

 in chronic American trypanosomiasis. 



Symptomatology. — A new-comer to an endemic district may notice 

 after a few weeks' residence that the neck has begun to swell, and 

 on examination this is found to be due to an incipient goitre. On 

 removal from the district, or after almost any method of treatment, 



Fig. 778. — Goitre in a Sinhalese Woman. 



the swelling will decrease. If, however, the person continues to 

 reside in the endemic region, the swelling will either continue or 

 return, and this will continue to occur until a more or less permanent 

 hypertrophy results. Usually the swelling affects the whole gland 

 uniformly, but often one lobe may be more hypertrophied than the 

 other. As time goes on the gland becomes permanently enlarged, 

 and may undergo cystic or adenomatous changes. 



Treatment. — The treatment consists in removal from the endemic 

 area, and in a course of intestinal antiseptics - e.g., salol and thymol, 

 10 grains night and morning. McCarrison recommends a poly- 



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