GOITRE.

Press, Volume LX, Issue 18014, 5 March 1924, Page 8

GOITRE.

INCIDENCE IN DOMINION.

EFFECT ON FUTURE GENERATIONS. (PKSS ASSOCIATION TELKOBAMS.) AUCKLAND, March 4. The serious incidence of goitre in New Zealand was discussed by the Medical Conference to-day, and a resolution was carried instructing tho Council to bring before the Government the urgent necessity of enforcing the addition of iodine to table salt.

In this connexion Professor Hercus (Dunedin) had explained that the manufacture of table salt in their efforts to put before tho public pure salt (sodium chloride) had in tho process of purification eliminated from the crude article substances including iodine, which had the highest value as dietary constituents.

A review of the Health Department's contribution to tho solution of tho problem was givon by the Director of the Division of School Hygieno, Dr. Ada Paterson, speaking particularly of the findings of school medical officers in tho past throe years. Tho cases in tho schools had been recorded, and the cases investigated by Professor I-lercus and Dr. Baker in Canterbury were classified according as they were incipient, slight, medium, v or large. Using this classification, there were three classes of children of which statistics were obtained—those in primer classes, of whom 5870 wore examined, those in Standard 11. (4281 examined), and those in Standard VI. (3826 examined). In all 19,930 children were examined. The results in three classes and the aggregate under tho various classifications were as follows: —

P. St. n. St. VI. Total. All degrees 10.43 21.19 24.65 15.73 Incipient .. 9.30 17.10 15.10 11.91 Small .. 1.04 3.67 7.60 3.22 Medium . 0.09 0.37 1.77 0.53 Largo ... 1.0 0.05 0.18 0.07

Dr. Pateraon drew attention to the steady increase in the number of cases as the higher standards were reached, where also was found a higher percentage of larger goitres. One point of interest was the largo number of boys found to have visible goitre. Thus in Canterbury, where the incidence of goitre was highest, Professor Ilercus and Dr. Baker found in the primer classes little difference in the incidence in boys and girls. At ado- ! lescence the percentage of boys afiected i decreased, the incidence in girls being at least twice as great. The result of attempts to treat children at school had been sufficiently encouraging. Facilities were now provided by which all schools in the epidemic areas might obtain treatment, consisting in. the administration of minute doses of iodine weekly for three school terms of eight weeks' each. Advice was also given as to general health and more particularly to the avoidance of constipation, the use of wholemeal bread, plain white bread, and the presence in the diet of plenty of green vegetables. Professor Hercus followed with a paper taking a wide survey of the subject. He said goitre was common in all countries, and was known at leaßt 2000 years before the Christian era. It was difficult because there was no pain, to convince the public of the seriousness of the disease, but endemic goitre was insidious to a degree. Sallow sk/in and mental dullness were some of its effects in New Zealand, .but it was to generations yet unborn in which its full significance would be found. The dictum of Morel was that goitre was the first halting place on the road to cretinism (idiocy). In a population of 3,000,000 in Switzerland there were over 120,000 cretins, and cretinoid idiots. The settlement of New Zealand was too Tecent for such an incidence to occut, but • already, after three, or at most, four, generations, cretinism wa:s making its appearance. Only a few cases in these areas were enough as a finger-post to the future. The economic importance of this aspect of the subject had already forced itself under the official notice of Switzerland, France, Austria, and Italy. That New Zealand's endemicity was high ' was sufficiently shown by Dr. Paterson's figures. Particular attention was drawn to the incidence among boys ( in Standards V. and VI. In a large school in Cliristchurch the incidence was 41 per cent, as observed a few days ago. This was an alarming fact. Dt. Hercus mentioned the causes, discussing particularly the theory that it was water borne whicii he finally dismissed. If water were a factor as seemed to be indicated by the cases ot Portland and Seattle, as there it was due to the absence of rather th.an the presence in the water of some sul>stance. This fact was well illustrated in Christchurch, when the low incidence of 14 per cent, of goitre was shown in Heathcote against 60 per cent, in Woolston. The artesian water at Heathcote was shown to be mixed to some extent with sea-water. "What then," asked Professor idLercus "is the modern conception of the causation of endemic goitre. Goitre is simply a compensatory reaction, a symptom depending immediately if not remotely on the lack of iodine. Whatever may be the ultimate cause, the immediate cause of enlargement is an iodine deficiency.'' Professor Hercus contended that the evidence supporting the conclusion was indisputable, stating that the active hornone of the thyroid was a very stable compound of iodine. The thyroid had an extraordinary affinity for iodine and that no goitre would develop if the iodine content of the thyroid were maintained. Professor Hercus proceeded to examine the sources of iodine in food, emphasising particularly that snowfed water supplies such as those used in Christcliurch were deficient in iodine. The iodine content of all food must also be directly related to the iodine content of the soil and was shown to be low or deficient in the great lowlands such as Canterbury and Southland. Professor Hercus 6aid the State could not afford to leave the supply of a deficiency so important as this, so significant to future generations, to the caprice of parents. Even if all children received iodine treatment, the State was confining its ef- | forte to only a limited portion of the community, the ages of 17 to 25 was equally important. Professor Hercus suggested either the addition of iodine to the water supplies in small quantities or its retention in salt up to' a certain proportion. To-day ordinary table salt contained 99.80 per cent, of sodium chloride. It was too pure. The passion for food refinement had again brought its penalty, and it was that one factor which explained to some extent the progressive increase in goitre from generation to generation. Dr. Mayo said it was accepted in America that goitre was not water borne. He referred to the work of the Mayo Clinic where T>r. Campbell had examined the thyroid glands of over 2000 ca- c es. He corroborated tho conclusions of Professor Hercus and Dr* Paterson. It was customary now in Rochester to administer iodine to a patient before nn operation, and to this was attributed a considerable reduction in the mortality rate from operations which was now less than 1 per cent. The result of the ensuing discussion was the passing of a resolution, relating to table vli