PATHOLOGY. 
238 
never found but where goitres exift, though the latter 
are often found without cretins. This feems to (how 
that only a more powerful application of the common 
caufe is necefl'ary to produce cretinifm. 
The precife nature of cretinifm is unknown. It is 
fuppofed to be a malady clofely allied to_ fcrofula. The 
fame may be faid of the next fpecies. It is well efta- 
blifhed that cretinifm is a difeafe of low and moift re¬ 
gions. Profeffor Fodere, in his Voyage to the Maritime 
Alps, had occafion to make numerous obfervations tend¬ 
ing to prove the truth of this opinion. Bronchocele, or 
goitre, and cretinifm, accompany each other in the ma¬ 
ritime Alps as they do in the Swifs mountains. Here, as 
well as in the valley of Aorta, Maurienne, and the Va¬ 
lais, they are not found in elevated regions; they are not 
feen at Saint Dahlias le Sauvage, nor at Molinet, nor at 
Tende and Briga; the maritime places, as well as cold 
and dry, or hot and dry, elevated regions, are exempt 
from them : but they are commonly met with in the hu¬ 
mid parts of both the northern and fouthern regions, at 
the foot of the fecondary Alps. They are mod frequent 
in the valley of Vifubia; and at Saint Martin de Lantof- 
ca the greateft part of the population has goitres; there 
are here, alfo, fifty cretins from birth : from hence we 
rife to Val de Blora, and thofe infirmities are no longer 
feen ; but, on defcending again into the valley Tinee, 
they are conftantly obferved until we arrive at Saint 
Etienne, where not a cretin was to be found. In general, 
in the valley Tinee, the inhabitants of the hamlets on the 
borders of the river which runs through it, are fubjedl to 
goitre and cretinifm, whilft thofe of the hamlets fituate 
on the more elevated parts are free from them. The 
Valley la Roja prefents alfo ftriking examples of the fame 
kind : there is not a cretin or goitre to be feen in the 
chief village in it, which is fituate on high ground, whilft 
they are numerous in the immediately furrounding re¬ 
gion, which is comparatively low. The w'hole of the 
author’s obfervations ferve to confirm his former remark, 
that goitre and cretinifm exift and take their courfe with 
the degree of the humidity of valleys, in all temperatures and 
climates. 
In the United States, Dr. Gibfon informs us, broncho¬ 
cele prevails as an endemic. It is very frequent in many 
parts of Lower Canada, efpecially near the marfhes be¬ 
tween St. John’s and Montreal. At Detroit, Lake On¬ 
tario, Oneida, Erie, Huron, and among the Tufcorora, 
Seneca, Oneida, and Brothertown, Indians, it is very 
common. In many parts of the date of Vermont, efpe¬ 
cially Bennington and Chittenden, bronchocele is well 
known. It is alfo found at Camden, Sandgate, and 
Chefter, in the fame ftate. Sandgate, fome years ago, 
contained ioao inhabitants, and out of that number one 
fourth of the females were affefted with the difeafe. Ac¬ 
cording to Dr. Trade, bronchocele is fo common a dif- 
order at Windfor in Vermont, that hardly any female is 
exempt from it. In the ftate of New York goitre prevails 
principally in the neighbourhood of Old Fort Schuyler, 
the Oneida-village, the German Flats, Fort Herkimer, 
Fort Dayton, Henderfon-town, Onondago-valley, Ca- 
nafaraga, Brothertown, the townfhip of Manlius, and the 
whole of the military diftridh At Angelica, in Alleg- 
hany-county, ftate of New York, goitre is a very fre¬ 
quent complaint. In Pennfylvania, where bronchocele 
is very common, it is found chiefly at Pittfburgh, on the 
waters of the Alleghany, Sandufky, Monongahela, French 
Creek, Cannonfburgh, Brownfville, and throughout the 
county of Somerfet. In fome parts of Virginia, efpecially 
at Morgantown and'on the banks of Cheat-river, it is by 
no means unfrequent. In certain fituations on the 
weftern fhore of Maryland, and in North and South Ca¬ 
rolina, the difeafe is occafionally met with. It is pro¬ 
bable, indeed, that goitre may be found as an endemic 
difeafe in almoft all the mountainous and marfliy diftrisSts 
throughout the United States. All writers on the com¬ 
plaint agree that it generally prevails in valleys at the 
bottom of the higheft mountains, which are particularly 
expofed to the influence of eafterly and foutherly winds. 
In thofe fituations, moreover, where the temperature is 
mild and uniform, where the atmofphere is moift, in the 
neighbourhood of rivers, of falls or lakes, or of the fea, 
where the foil is rich and the habitations furrounded by 
fruit-trees, goitres are commonly found. 
We (hall now fpeak of the Englifh, or curable broncho¬ 
cele. The feat o( this difeafe is the thyroid gland, which 
lies juft below the larynx, round the trachea. The tu¬ 
mour appears in the fore-part of the neck, between the 
(kin and the wind-pipe. Women are the moft frequent 
fubjedts of it; and in them it ufually appears early. Dr. 
Hunter met with one cafe of this kind in a young fur- 
geon ; but it is rarely happens in males. 
The cretinifmal bronchocele is a tumour arifing on 
the fore-part of the neck; it generally firlfc appears fome 
time betwixt the age of eight and twelve years, and con¬ 
tinues gradually to increafe for three, four, or five, years; 
and fometimes the Lift half-year, we are told, it grows 
more than for a year or two before. It generally occu¬ 
pies all the front of the neck, for the whole thyroid 
gland is enlarged ; and it is of a pendulous form, not 
unlike, as Albucafis fays, the flap or dewlap of a tur¬ 
key cock, the bottom being the larger part of the tu¬ 
mour. In figure, it varies confiderably in different cafes. 
It is foft, or rather flabby, to the touch, and fornewhat 
moveable; but, when it has continued fome years after 
it hai' ceafed to increafe, it becomes more firm or con¬ 
fined. By the fituation and nature of the complaint, it 
generally occafions a difficulty of breathing, which is in- 
creafed on the patient’s taking cold, or attempting to 
run. In fome the tumour is fo large, and fo much af- 
fefts the breathing, as to occafion a loud wheezing. 
Patients, however, fometimes fuffer but little from a 
large tumour, while others fuffer much from an inconfi- 
derable one : in general, however, it occafions little incon¬ 
venience. Dr. Hunter obferved, that the tumour now 
and then fuppurates. 
The bronchocele fhould be diftingnifhed from a fchir- 
rhus, from an aneurifm, and from thofe fwellingsin the 
neck that arife from drains or ruptured veflels. The 
diftin&ion however is not difficult. 
An iffue, or a perpetual blifter, applied on fome other 
occafions, has apparently prevented the growth of the 
bronchocele, though the effect continued only during 
the irritation. It cannot be extirpated, as it is entangled 
with the recurrent neryes, and the firft branch of the 
external carotid artery; and,if by chance a fuppuration 
is formed, an ill-conditioned ulcer, difficultly cured, is 
the confequence. In addition to the above direflions, 
attention to the ftate of the general health, and the re¬ 
gular exhibition of large dofes of uva urfi, or foda, com¬ 
prehends all the treatment. If not cured before the age 
of puberty, at which time it fometimes amends fponta- 
neoufly, little fuccefs can be anticipated. 
This applies to the common bronchocele of this coun¬ 
try. Occurring under the form of cretinifm, as feen in 
the alpine regions, we are not aware that any treatment 
has been very fuccefsful. Dr. Wylie, of Peterfburg, is 
faid to ufe, with good effeft, fridtion with an ointment 
compofed of § fs of litharge ointment, 3j of calomel, 
and gr. x. of tartrite of antimony. And we learn in the 
Appendix to Dr. Clark’s “ Notes on France, Italy, &c.” 
that M. Quadri thinks highly of the treatment by feton. 
“ I find,” fays he, “that all goitres of a foft confidence, 
and not arterial, were cured quickly and fafely by the 
feton. Of twelve individuals on w'horn the operation 
was performed, eight were perfectly cured.” Probably 
removing to a higher fituation, and living in the belt 
manner, might in the courfe of a few generations exhauft 
the difeafe. See Cretins, vol. v. 
2. Cyrtofis rachia, the rickets: chiefly affedting the 
limbs and body; fpine crooked ; ribs deprefled ; articu¬ 
lar epiphyfes enlarged and fpongy ; belly tumid ; mental 
faculties clear, often premature. 
Ufually the firft appearance of rickets is in the eighth 
or 
