A system of practical medicine. By American authors. Vol. 3

by Unknown

That water, however, does become the medium for certain materials which, taken into the system, produce enlargements of the thyroid, is unquestionably true. In corroboration of this statement we have two notable facts recorded by Frank, who says that at Rheims, where goitre was very common, quite one-half of the tumors disappeared after the source of the old water-supply was abandoned and the town supplied by a branch from the river Verle. And again at Stenseifen, near Schmideberg, where goitre prevailed as an endemic, the disease disappeared on the closing of a fountain which furnished water to the inhabitants of the place.

Atmospheric causes have also been invoked in order to shed light on the production of goitre. Thus it is said that the common occurrence of the latter in very deep valleys, so overshadowed by the dense foliage of timber as to prevent a proper interchange or circulation of air, is favorable to this theory; yet as against this view we have the statement of Humboldt, who says that on the plateaus of Bogota, which are swept by constant currents of air and are quite sterile in vegetation, goitre is common.

That local or geological conditions do exist which are directly concerned in the development of endemic goitre cannot be gainsaid, and these of so active a nature that persons coming from remote districts into such goitrous centres and entirely free from all enlargements of the gland, are liable to suffer in common with the native born. Not only so, but, as has been observed by Virchow, even domestic animals in such localities become subjects of the disease.

The very careful study of this subject by Labour of Newcastle, England, furnishes strong evidence that water passing through calcareous soils alone had little if anything to do with goitre, but when such soils were impregnated with ferruginous and earthy salts the geological conditions were present for developing the disease.

Enlargement of the thyroid body is occasionally seen as one of the late manifestations of syphilis, usually bilateral and attaining in some instances a great size.

Gestation is another and not an uncommon cause of goitre, the tumor appearing in the last months of pregnancy or immediately after parturition. Three cases clearly traceable to the above cause are under the writer's care while penning this article. It is in such cases that the tumors sometimes grow with frightful rapidity. Roberts reports three cases in primiparæ, all of which ran an acute course and terminated fatally by asphyxia.

In Graves' or Basedow's disease goitre forms one of the elements in the morbid circle, and when thus associated may be regarded as a neurosis.

VARIETIES.—Goitre appears under different forms, and not unfrequently one variety is transformed into another. The following classification, resting on a pathological basis, will be adopted, namely—Follicular; Gelatinous; Cystic; Fibrous; Vascular.

In follicular goitre there is a proliferation, both in the cell-elements of the follicles and in the connective tissue constituting their walls. This general hyperplasia of the normal histological components of the gland constitutes a tumor which, for a time at least, remains quite soft and compressible, even communicating to the touch the sensation of fluctuation. The tendency, however, of the growth is not to remain long in this condition, but to become more firm and even hard to the feel.

The fibrous is often a transformation from the follicular goitre, an advanced stage in the life-history of the latter. There occurs a new formation of interstitial connective tissue, which by its accumulation and encroachment upon the follicles lessens, and finally obliterates, them to a degree which converts the gland into a fibroma. It is rare, however, to find this metamorphosis general. Generally the change is limited to portions of the thyroid, and accordingly the tumor in this variety of the disease is found hard, knotty, and incompressible at different points corresponding to the sclerosed portions. The vascularity of the fibrous variety is quite insignificant in those portions of the gland which have been the subject of this morbid change, though in other parts there is a liberal supply of blood-vessels.