460 
BUIvI^ETlN OF THE BUREAU OF FISHERIES. 
There is a family at present at Nagar which consists of nine souls, of these three came from Gilgit 
some years ago, all suffering from goiter. Two, the father and the mother, have no goiters; the father 
came from Gilgit. The remaining four individuals have never been outside Nagar. Three are high- 
caste Mohammedan girls (16, 15, and 10 years of age), which makes the statement the more likely to be 
accurate. The fourth individual is a boy aged 12; he has never been outside Nagar. All of these four 
developed goiter about two years ago. This family lives in the same house, that is, the same room, 
eat out of the same vessels, etc. It is to be observed that these, the first victims, are all young. 
Another family consists of a man, his wife, and son, aged 2, and the man’s brother, aged 20. The 
man brought goiter with him from outside five years ago. Two years later his brother developed the 
disease, though he had not been outside Nagar for five years. The little boy, aged 2, developed the 
disease one year ago; the wife is free from it. Another man, aged 23, brought the disease from Gilgit 
one year ago; it is increasing in size here. 
Twelve children, all under 10 years of age, were brought to me having marked enlargements of the 
gland. There are no other cases of the disease in Nagar. The children were from different houses 
scattered over the village. The first family to which I referred lives at the head of the spring which 
supplies the village with drinking water. 
The village supply consists of a spring which comes out of the hills; it is not the only supply of the 
village. The cases I have referred to all drank from this water. This spring is said to have been in 
existence from time immemorial; the chemical composition of its water has presumably not altered. 
The conditions of life of the people are the same. The only added factor in the case is the introduction 
of the disease from without. That it is spreading there can be no doubt, and that the course of the spread 
is a typically endemic one is equally evident. It is easy to understand why the disease should not 
have reached Nagar earlier, as it is only within recent years that the communications of Nagar with the 
outside world have become free. 
It appears evident also that it is by means of the spring water that the disease is now spreading, 
for the 12 children are residents of that part of Nagar supplied by the spring, and their homes are scat- 
tered here and there among the houses of the yet unaffected inhabitants. Further, the fact that the 
first family referred to lives at the head of the spring is of importance, and also that no cases of this 
disease were observed where water from other sources only is drunk, that is, in the distant parts of the 
village where the nullah water or the river water is used. 
It seems likely, therefore, that some poison, goiter producing in its powers, has been introduced 
into a water supply which happened to be suitable for the conveyance of this disease. 
This case of Nagar can not be explained by any theory which attributes to dissolved ingredients 
In a water goiter-producing properties; nor can inorganic matters in suspension account for this outbreak; 
for it can not be supposed that from causes in the water which have existed from time immemorial a 
disease should suddenly spring. There is, to my mind, only one explanation, namely, the introduction 
of an organism into the water supply. 
