How can we account for this particular intensity toward the middle of the valley? Why is it that crétins become more and more numerous after Ivrea is passed, attain their highest ratio and lowest degradation at or about the chief town of the valley, and then diminish in numbers as its upper termination is approached? This maximum of intensity must certainly point to a cause, or to a combination of causes, operating about Aosta, which are less powerful at the two extremities of the valley; and if the reason for it could be determined, the springs of crétinism would be exposed. The disease would be even more puzzling than it is if it were confined to this single locality, and the inquirer were to find not merely that it was almost unknown upon the plains to the east and in the districts to the west, but that the valleys radiating north and south from the main valley were practically unaffected by it. For it is a remarkable circumstance, which has attracted the notice of all who have paid attention to crétinism, that the natives of the tributary valleys are almost free from the malady—that people of the same race, speaking the same language, breathing the same air, eating the same food, and living the same life, enjoy almost entire immunity from it, while at the distance of a very few miles thousands of others are completely in its power.
A parallel case is found, however, on the other side of the Pennine Alps. The Rhone valley is almost equally disfigured by crétinism, and in it, too, the extremities of the valley are slightly affected compared with the intermediate districts—particularly those between Brieg and St. Maurice.[[54]] This second example strengthens the conviction that the great development of crétinism in the middle of the valley of Aosta is not the result of accidental circumstances.
[54] It was stated a few years ago that one in twenty-five of the natives of the Canton Valais (which is chiefly occupied by the valley of the upper Rhone) were crétins. This would give about 3500 to the canton. At the same time the valley of Aosta contained about 2000 crétins.
It was formerly supposed that crétinism arose from the habitual drinking of snow- and glacier-water. De Saussure opposed to this conjecture the facts that the disease was entirely unknown precisely in those places where the inhabitants were most dependent upon these kinds of water, and that it was most common where such was not the case—that the high valleys were untainted, while the low ones were infected. The notion seems to have proceeded from crétins being confounded with persons who were merely goîtred, or at least from the supposition that goître was an incipient stage of crétinism.
Goître, it is now well ascertained, is induced by the use of chemically impure water, and especially hard water; and the investigations of various observers have discovered that goître has an intimate connection with certain geological formations. In harmony with these facts it is found that infants are seldom born with goîtres, but that they develop as the child grows up, that they will sometimes appear and disappear from mere change of locality, and that it is possible to produce them intentionally.
It is not so certain that the causes which produce goître should be regarded as causes of the production or maintenance of crétinism. It is true that crétins are very generally goitrous, but it is also true that there are tens of thousands of goitrous persons who are entirely free from all traces of crétinism. Not only so, but that there are districts in the Alps and outside of them (even in our own country) where goître is not rare, but where the crétin is unknown. Still, regarding the evil state of body which leads to goître as being, possibly, in alliance with crétinism, it will not be irrelevant to give the former disease a little more attention before continuing the consideration of the main subject.
In this country the possession of a goître is considered a misfortune rather than otherwise, and individuals who are afflicted with these appendages attempt to conceal their shame. In the Alps it is quite the reverse. In France, Italy and Switzerland it is a positive advantage to be goîtred, as it secures exemption from military service. A goître is a thing to be prized, exhibited, preserved—it is worth so much hard cash; and it is an unquestionable fact that the perpetuation of the great goitrous family is assisted by this very circumstance.
When Savoy was annexed to France the administration took stock of the resources of its new territory, and soon discovered that although the acres were many the conscripts would be few. The government bestirred itself to amend this state of affairs, and after arriving at the conclusion that goître was produced by drinking bad water (and that its production was promoted by sottish and bestial habits), took measures to cleanse the villages, to analyze the waters (in order to point out those which should not be drunk), and to give to children who came to school lozenges containing small doses of iodine. It is said that out of five thousand goitrous children who were so treated in the course of eight years, two thousand were cured, and the condition of two thousand others was improved; and that the number of cures would have been greater if the parents “had not opposed the care of the government, in order to preserve the privilege of exemption from military service.” These benighted creatures refused the marshal’s bâton and preferred their “wallets of flesh!”
No wonder that the Préfet for Haute-Savoie proposes that goitrous persons shall no longer be privileged. Let him go farther, and obtain a decree that all of them capable of bearing arms shall be immediately drafted into the army. Let them be formed into regiments by themselves, brigaded together and commanded by crétins. Think what esprit de corps they would have! Who could stand against them? Who would understand their tactics? He would save his iodine and would render an act of justice to the non-goîtred population. The subject is worthy of serious attention. If goître is really an ally of crétinism, the sooner it is eradicated the better.
De Saussure substituted heat and stagnation of air as the cause of crétinism, in the place of badness of water. But this was only giving up one unsatisfactory explanation for another equally untenable; and since there are places far hotter and with pernicious atmospheres where the disease is unknown, while, on the other hand, there are situations in which it is common where the heat is not excessive, and which enjoy a freely circulating atmosphere, his assumption may be set aside as insufficient to account for the crétinism of the valley of Aosta. And in regard to its particular case it may be questioned whether there is anything more than an imaginary stagnation of air. For my own part, I attribute the oppression which strangers say they feel in the middle of the valley not to stagnation of air, but to absence of shadow in consequence of the valley’s course being east and west; and believe that if the force of the wind were observed and estimated according to the methods in common use, it would be found that there is no deficiency of motion in the air throughout the entire year. Several towns and villages, moreover, where crétins are most numerous, are placed at the entrances of valleys and upon elevated slopes, with abundant natural facilities for drainage—free from malaria, which has been suggested as accounting for the crétinism of the Rhone valley.