GOITRE PROBLEM

Evening Star, Issue 22191, 20 November 1935, Page 3

GOITRE PROBLEM

PREVENTION CDMPARATIVELY SIMPLE ADDRESS BY DR C. E. HERGUS The problem of goitre in New Zealand was dealt with by Dr C. 10. Kerens in an address giveli yesterday afternoon at the annual meeting of the Otago branch of the Royal New Zealand Society for the Health of Women and Children. “ Goitre could become a rarity in a generation if we really set ourselves to eliminate, it,” said Dr C. E. Herons. “ Man has been wrangling about the cause of goitre since it was lirst described some 2,000 years before Christ, but in spite of all the conflict of opinion there is general unanimity that the problem of prevention is a comparatively simple one and that if our existing knowledge could be effectively applied goitre might become a rarity'in a generation.” Dr Kerens impressed on his audience the necessity for an adequate iodine content in the diet, and urged that women and children particularly, should use iodised salt for all purposes and should supplement it by the addition of fish or some seaweed preparation. VARIOUS FORMS. It had to be recognised, said Dr Kerens, that there were various forms of goitre, the principal types being the so-chlled simple goitre, though this name was really a misnomer, for the effects on the individual and the race were by no means simple. There was also the variety known as toxic, or poisonous, goitre where the individual affected was frequently very ill and presented a very characteristic train of symptoms which might, in some cases, bo recognised by the layman. It was this type of goitre alone that was considered at the recent British Medical Association Conference in Melbourne and concerning which Sir Thomas Dunhill had stated that the cause was as yet unknown. “There are many theories as to the causation of toxic goitre, but Jew facts,” added Dr Hercus, “ although we do know that it affects women much more commonly than men and that it is common in the third decade of life. 'Although there is general agreement that the best treatment of this type of goitre is by removing part of tlie thyroid _ gland, there is no certainty that this gland is the primary and essential factor in the causation of the symptoms. The excessive amounts of secretion which are being poured out by the gland in toxic goitre are probably due to the action of some factor external to the gland itself. We know, for example, that the master gland of the body, the pituitary, which is situated at the base of the brain, plays an important part in controlling the" thyroid as do other glands, such as the Suprarenal glands. The. whole chapter which is at present being unfolded with regaid to the inter-relationship of these glands of the body is one of the most fascinating chapters in modern physiology. The essential fact, however, that concerns ns here is that this form of goitre is much more prevalent in New Zealand than in Great Britain or Australia. It is also a fact that the districts of New Zealand which show a high incidence of simple goitre show also a high incidence of toxic goitre. This is a most significant finding and suggests that whatever may he tlie cause of toxic goitre, it operates more readily on an enlarged gland than on a normal one, and indicates also that prophylactic measures designed to prevent simple goitre would also reduce the amount of toxic goitre in this community. If we prevent the one, we reduce the other.” SIMPLE GOITRE. Referring to the so-called simple goitre, which was still so common in New Zealand, Dr Hercus said it occurred among the inland tribes of Maoris before the white man came, ami was known as Tenga. The late Mr Elsdon Best had informed him that, in 1575, when surveying in the Urewera country, he found that goitre was very noticeable among the women of the Tnhoe tribe. During an investigation in this 'district in 1925, Dr Hercus had found that there was still a high incidence of goitre among these people, whereas members of the same tribe living in the Wbakatane-Rangitikei district had a much lower incidence. The first reference to a goitre problem among the European population of New Zealand was made by Dr Hacon in Christchurch in 1888, some 30 years after the establishment of the Canterbury settlement. Many other surveys of the population had been carried out by medical officers of health, school medical officers, and others, and had established the fact that the disease was still widely prevalent in New Zealand.

Dr Wyn Irwin, in a recent survey of mothers anti babies carried out under the auspices of the Plunket Society, had found 44 per cent, of 341 mothers examined to be affected, and also 19 per cent, of children under eight years of age. If any confirmation was needed of the validity of these figures, added Ur Hercus, it was only necessary to turn to the admissions to the public hospitals of the Dominion on account of goitre to find that in 1933, for example, 975 people were admitted for treatment, and to refer to the causes of death to find that in the same year 66 people died on account of the disease. There had been an upward tendency in the hospital admissions during recent years. “ It can therefore be stated without fear of contradiction,” he said, “ that an undue percentage of the thyroid glands of the inhabitants' of this Dominion are working overtime. An interesting fact,, which has been recorded recently in Taranaki, is that there has been a significant increase in the incidence of goitre among' the school children during recent years. These epidemics of goitre are on record in most goitrous countries of the world, and have been frequently recorded among animals' in Otago and Southland.” DEFICIENCY IN lODINE. As far as New Zealand was concerned, Dr Hercus continued, no new facts had arisen to suggest any departure from the hypothesis that simple goitre in this country, was due primarily to a deficiency in environmental

iodine. All the evidence suggested that the immediate cause of goitre was failure of the thyroid gland to obtain an adequate supply of iodine. While this was a fundamental fact, no student of _this_ subject would maintain that iodine intake was the sole factor in the prevention of goitre. A multitude of factors played their part. Any factor which increased the need of the body for iodine might create a relative deficiency and produce goitre, infective processes, for example, were frequently responsible. There were also active goitrigenic factors which might produce goitre. This goitre-producing substance was common in cabbages and in other members of the brassica family. “ We have been investigating the importance of this factor in Zealand for the lust four years,” Dr Hercus added, “ and have shown that, while in certain districts it is important, it cannot be recorded as being of more than minor interest. Vitamin C deficiency has been shown also to increase the demand for thyroid activity, as to diets rich in fat. We have used our goitrefree. dependency of Samoa for a comparative study in the intake and output of iodine in relation to goitre, and we have established the fact that the only significant point of difference between the two countries is this environmental deficiency in iodine. When iodine is in sufficient amount pathological changes do not occur in the thyroid gland. When iodine is insufficient the gland is sensitive to many disturbing influences, none of which a re‘effective in high iodine areas.” lODISED SALT. The general use of iodised salt for all purposes in endemic areas had received universal recognition as the most efficient plan of goitre prophylaxis on a national scale, continued Dr Hercus. This method of prophylaxis was introduced into New Zealand in June, 1924. and though there was a steady upward rise in the extent to which it was used, it was disappointing to find that only a small percentage of the total salt imported to this country, for domestic use'was iodised. In 1933, for example, over 700,000 cwt of salt was imported into New Zealand, of which amount only 19,000 cwt was iodised. This was equivalent to 1.4 grams per person per day, which would .supply an average of 4.2 inicrograms of iodine, which was totally inadequate for preventive pur'poses. Where this method of prophylaxis had been properly used it had proved effective, although there were isolated records of goitre developing among people who had been using iodised salt faithfully for the table and cooking purposes. “ If we take the Samoan level as being the'optimum .to which we should raise our iodine intake,” Dr Hercus continued, “ the present concentration of iodine in iodised salt would appear to be too iow, and this may" require further consideration by the’ Government. Ju the meantime we must urge, in season and out of season, that all women and children particularly should use iodised salt for all purposes and that they should supplement this bj - the use of fish or some seaweed preparation. In health matters one frequently wishes that the Government would exercise the same powers of benevolent autocracy which it used to such effect in our equally personal financial matters. Apparently the New Zealander must be left free, however, to exercise his geographical birthright to acquire goitre, for tlie Anglo-Saxon resents any compulsory measures in connection with his dietetic habits. We must continue evidently to follow the slow road of public education, and 1 would urge the Piunket Society to concentrate increasingly on combating this malady, which is the actual and potential cause of much illbealtb among our citizens.” Dr Hercus was accorded a vote of thanks on the motion of Dr Martin Tweed, medical adviser to the council of the Plmikei Society,