GOITRE

Evening Post, Volume CVIII, Issue 63, 11 September 1924, Page 7

GOITRE

GROWTH IN NEW ZEALAND

A. SIMPLE REMEDY

HEALTH DEPARTMENT'S CAMPAIGN.

Recently "The Post" has published several articles in reference-to tho prevalence of goitre in Sew Zealand and the special measures that are being taken by the Department-o£ Health to dear-with it. Professor / Hercus, of the Medical School of i Otago, by'means of a grant from the ..■.Government;; is carrying out investigations into tlie iodine content of soil and vegetables in -various parts of . New Zealand. When this survey is completed valuable information should be afforded the Department as indicating the districts which should be concentrated upon for the adoption of; prophylactic measures. The School Medical Service of the Health Department is this year undertaking the administration of minimal doses of iodine preparations to school children in specially selected areas. This work, which has been under way for two or three years, has produced satisfactory andi encouraging results. Lately, in the food and drugs regulations recognition was made of the fact that the addition of iodine to common salt is a most uss'ful means of prophylaxis against this disease. A regulation has been introduced allowing the sale of salt containing iodine. When Professor Hercus has completed his research work and the full information is in the hands of the Department, it is possible that the use of iodised salt may be made compulsory in certain districts where there is strong. indication for its need. .. RESEARCH' WORK" QF PROFESSOR HERCUS. : It is recognised by high medical authorities, including the distinguished American surgeon; Dr. W. J. Mayo, who recently. visited Now Zealand that such researches as those now being carried out by Professor Hercus and others may prove one of the greatest advances in health1 matters of recent years. Until recently, Dr. M'Carrison was considered one of tho greatest authorities on the .causation'of goitre. He believed that water caused goitre on account of the impurities and contamination it contained. Therefore, - people were advised to boir their drinking water. Now it lias been found that that is useless. Water has been found to be tho indirect cause in certain localities, not on account of what it contains, but what it does not contain, namely, iodine. Too much praise, it is asserted, cannot be accorded to the School Medical Department for provisionally mapping-out the goitre districts of New Zealand. It has remained for a young New Zealander, Professor Hercus, to ask and answer the question:. Why is it that the waters of one part of New Zealand contain sufficient- iodine, and not' in others? It is considered that it. is rightly .suggested that the waters obtain, their salts from tho soil. To prove this, he has analysed the soils of districts both affiliated and free from goitre, and he has found extraordinary Tesults—results which greatly impressed our . distinguished medical visitor, Dr. W. J. Mayo, when he was here recently. Hero it maybe mentioned that at the-Mayo Clinic in America' 2000 operations on ; goitre .are I performed .yearly. At this : clinic, it may be added, much original work has been done in relation to the causation of goitre. The New Zealand branch of the British Medical Association, it -is understood, urged the Government to make a grant so that the researches of Professor Hercus might be pushed forward on a more extensive scale.

A DEVITALISING DISEASE. It is pointed out by medical authorities that goitro is one of the most dovitalising diseases. A goitrous youth means an unstable manhood and liability to nervous breakdowns. And more important still, .tliero is the fact that in countries like Switzerland it is noted that; a p-eneration in which goitre is prevalent is invariably followed in the next generation by an unduly largo proportion of cretins and imbeciles. There is every reason to believe Dr. Mayo when he said that when he got back home, and told themHhere what Professor Hercus is doing here, they would want him in America, and would pay him well. There is,./therefore,' a possibility that America may induce another brilliant man engaged in research work to take \ip work in the United States. ■': ; '

SUMMARY OF EFFECTIVE ": ,- MEASURES, :'.. The following article ' from "The World's Health" gives in concise form a summary. of the various measures taken in different parts of the world. The article refers to the addition of iodine to salt. As indicated above, the New Zealand Department of Health has not neglected this phase of the matter, for in the recent regulations provision is made for the sale of salt containing iodine.

"Geographically, the distribution of goitre is almost world-wide. Thus we find it prevalent throughout the Alps in Southern Europe, in South-eastern France, Southern Germany, Southern. Austria, Northern Italy, and in many parts of Switzerland. In the Himalaya district in Asia, we find goitre occurring in Northern India, -in. ■ .South-western China, and in Eastern Mongolia. In South. America- wo find it in ; the Ancles, in the Peruvian Plateau, and iii Western Brazil, and "in North America--around the- great lakes, the St. -liiiw-. rdiice basin, and in the North-western Pueiliu region. Fow countries are altogether free from the disease; it occurs, for example, in certain districts in England ('Derbyshire' neck'); and even in the" places mentioned above, goitre is foundttvo v occur more in onesubdivision than in another. , "With .such a universal distribution, it is not surprising that Die subject of simple goitre has received the attention of many investigators who have attempted" along scientific lines •to discover the cause of this disease. Many theories- have been advanced, and, as is usual in sciontilie research where .there aro many theories, we are probably not at the truth. Some maintain that tlie cause lies in the drmking water, that owing to certain conditions this water contains parasites which cause the di- ■ Kease, or alternately that it does not contain necessary substances. Others consider the disease to be a form of poisoning, either from certain oulside sources or by the absorption of poisons from certain parts of our own bodies.

LACK OF TOJTINK. "While, the ultimate and remote ennso of goitre is not known, it, is founrl that, one. o{ the iiniucsdiiifc or determining factors is a lack of iodine. Tho thyroid ghmd is constantly manufacturing and turning' into the blood stream, a substance which is essential to the life of the individual, and for this manufacturing- process it requires iodine us one of its raw materials. -K.oe.her estimated some time ago that 80 per cent, of the school children in TJcrnc suffered with goitre, l.eadiug lv much unpainucui.- of-health, ami, euu-

sequently, of "social value." A diseaso which can attain such alarming proportions has naturally been liiuch studied since the earliest times. Tho ancient Greeks treated goitj'o by administering the ash of burnt sea. sponges—a, substance which has subsequently been dis- ! covered to bo rich in iodine, and people (.living on the sea coast never get simple goitro for the very reason that iodine is [present in their drinking water, their vegetables, and in the very air they breathe. Goitre, therefore, becomes an easy disease to prevent—simply by tho administration of iodine. This was discovered to be tho case when crude salt found in Michigan was given to sheep, among which goitre was rife, with splendid results, and iodine was subsequently discovered to bo present in the salt. VALUABLE PREVENTIVE -." MEASURES'..' "Whatever be the cause of goitre, then, from a public health point of. view, there are-valuable-preventive measures available. The question of general: hygiene must not be forgotten; some authorities look upon this as very important, and pay great attention to the. improvement of drinking water supplies and to the personal hygiene of individuals in goitrous districts. Others, believing in the infectious theory of the disease, administer disinfectant substances to persons with goitre, and report beneficial results. The special measures at our disposal centre round the administration of iodine in some form, or other. lodine may be absorbed from the air we breathe—we can wear amulets which give off an iodine vapour, or we can place ■wide-mouthed bottles containing iodine solution in houses and public buildings. Certain crude kitchen salts contain iodine in sufficient quantity to prevent the formation of goitre if the normal amount of salt is consumed, as is found to be tho case iv Bordeaux. In other places iodides may be added to the common salt. Thus, in Switzerland, it is recommended to add potassium iodide in the proportion of aquarter to half a gramme to each fifty kilogrammes of common salt, and it is stated that the amount of common salt used per person per year is five kilogrammes.' It. parts of America a, mixture of sodium iodide and sodium chloride is sold for domestic use as "Nu-sajt." In Austria, potassium iodide is added to kitchen salt in less than one-tenth of tho amount used in Switzerland, and what is known as "full-salt" is distributed in goitrous districts, as, for example, in the Austrian Tyrol. Another measure which is used is the administration of iodine as a drug. The three main periods of danger from the point of view of goitre formation are the foetal, tho adolescent, and dining pregnancy. If, then, we administer iodines to pregnant women and to growing children, the prevention of much goitre will be effected. In America, the usual, procedure is to administer an amount equivalent to two grammes spread over two weeks, and for two -, courses'a year. In England, the recommended dose in the'goitrous districts is two grains daily for ten days twice a year. In Switzerland, a special organic compound of iodine is used and'eombined with chocolate to make tablets, each containing five milligrammes of iodine. The schools in both America and Switzerland are looked upon as, valuable points of attack, for here iodine can be administered as described above with great exactitude, and results can be watched. The dangers resulting from the use of iodine in such«a fashion are found to be negligible. Only a very small percentage ever showed any signs of ill-effects in hundreds of cases in which theso methods have been employed in schools. -..-'■'

.' „ STRIKING PROOFS. Theresults of such preventive measures as described above, are a sufficient to their efficiency. Over a period of three- years, and amongst 10,000 girls examined in Akron, Ohio, by Drs. Maine and Kimball (pioneers of'this movement in America), there were striking results., About half the girls elected to take the treatment, and 79.7 per cent, of those with moderately enlarged thyroids showed a decrease in size of the gland as compared with only 12.4 per cent, of those who were1 not taking treatment. In St. : Gall, Switzerland, iodine prophylaxis was in force, for three years, ''■ with most striking results.. While tho possession of a goitre may be essentially an individualistic experience., the problem of goitre prevention as a whole is one which affects tlie community in any goitrous district. It is by education along health lines that a community can be encouraged to mobilise its resources and fight this disease, just as it would fight, for example, for the reduction of infant mortality. There is scope in districts where the condition is still prevalent for voluntary organisations to lead the way to the adoption of preventive measures. . . '"A THING OF THE PAST." ; In attacking the goitre problem, public health authorities, have nob. had the advantage of knowing the causal factor as they have in some other diseases where the parasite or the bacillus is well known. Despite this handicap, however, preventive medicine has once again triumphed, and it is not too much to hope that the time will soon come when goitre will be a thing of the past in "every civilised country in ■ the world..