"The prevalence of Goitre in New Zealand, and its influence on the coming Generation"

Kai Tiaki : the journal of the nurses of New Zealand, Volume XII, Issue 3, 1 July 1919, Page 111

"The prevalence of Goitre in New Zealand, and its influence on the coming Generation"

An address delivered by Professor A. Murray Druman to the Annual Meeting of the Royal N.Z. Society for the Health of Women and Children, Thursday, 22nd May, 1919, m the City Chambers, Dunedin.

Introductory. — Mr. Chairman, Ladies and Gentlemen,

You may think the title and subject of this address somewhat irrelevant but I hope to convince you that it is one of first importance to our welfare here. In developing the subject it will be necessary to employ a few technical terms and I ask you to bear with me m the use of these which are unavoidable for the proper presentation of the matter.

The New Zealand Official Mortality returns only deal with exophthalmic goitre, a variety fortunately not very common, and consequently these returns are comforting for the figures given for fatal cases directly due to this type of malady are quite small. But what the Mortality Returns do not show, what no returns at present show is the extreme prevalence of what is termed '"Simple Goitre*' especially m women.

Definition. — Goitre is a term applied to any form of enlargement of the gland m the neck known as the Thyroid Gland, which when it enlarges causes an appearance popularly described as "Thick Neck.*' In a minor degree it is considered a mark of beauty and is freely exhibited by the present fashion m female upper garments.

Function of Thyroid depends on the active principle manufactured by the cells of the gland. This principle has recently been isolated m a pure crystalline form by Kendall m America,* and he has shown clearly, what was long known, that lodine is essential for the proper formation and action of this substance. Absence of the thyroid, or atrophy of it, means loss of its special secretion and results m a curious condition known as Myxoedema, a condition m which all the body functions work at a slower rate, the victim becomes sluggish, stupid and altered m many ways. Such is the effect on the adult. In children an equally curious change occurs, thechilcl is stunted, physically, mentally and morally, and if untreated remains m a state of idiocy. Excess of thyroid secretion results m an acceleration

of all the bodily functions, indeed an overactivity, which, m extreme cases results m what is virtually a burning up of the body, with wasting and final exhaustion. Experiments m which the isolated thyroid gland has been perfused with lodine have shown that the gland can take up, and manufacture its special secretion or "hormone," and then store this. And other experiments show that the gland can be made to secrete by stimulation of certain nerves. This stimulation and secreting mean a loss of stored secretion and are associated with certain active changes m tho gland" s cells. Normally the gland is always responding to demands made upon it so that a normal variation between activity and resting states is always going on to some extent. So much for the normal physiology of the gland, what of the pathology.

Pathological changes m Goitre occur m response to abnormal demands on the gland, or as a result of deficient or disordered supply of raw material to the gland, i.e., the changes are compensatory. All goitres are at first m the nature. of increased glandular activity — what is called hypertrophy and lryperlasia — following this initial disturbance several things may happen, the activity may persist and result m the clinical picture of exophthalmic goitre, or, more commonly, the gland reverts to a resting state but slightly enlarged; active changes again occur, and so on, the process may oscillate but each oscillation leaves a further mark on the gland and sooner or later secondary changes occur — haemorrhages, various degenerations, etc. The process may extend over years and may not give rise to any particular trouble, but il is always a potential source of trouble and often a source of chronic invalidism. These changes are much more common m women and often start from 12 to 16 years of age and are liable to' increase and cause trouble at the various momentous times which occur m the female economy. It would be out of place to weary you with the varieties of pathological changes which may occur

as these are merely evidence of established damage.

Aetiology. — What is the meaning of all this, and why should goitre occur? It is a problem which has vexed many people and given rise to all sorts of theories. The two most prevalent are that (1) goitre is m some way related to the water supply, (2) that it is the result of infectious agents.

Dr. Colquhoun some years ago instituted an enquiry as to the water supply and its relation to goitre m different parts of New Zealand and his investigations showed that goitre might be found with very different sources of water supply. Major — now I think Lieutenant-Colonel McCarrison, of the 1.M.5., has published a book on the Thyroid Gland and Goitre. He based his observations on certain isolated hill tribes m Cashmrr. He strongly supports, and proves to his own satisfaction, that goitre is due to bacterial infection of the water supply. Of certain native villages along a stream, those on the upper reaches had a small proportion of goitres among the inhabitants, while those further down had an increasingly large proportion of goitres. There is another possible factor involved here which I need not touch upon. But what he does bring out is of the greatest importance generally, and especially to this Society, it is that the children of these goiterous mothers were frequently born defective, m a condition of cretinism, due to deficient thyroid secretion.

Animals show changes exactly parallel to those m man and a study of animal goitres has recently thrown much light on tho fundamental factors m the production of goitre. David Marine, of the Western Reserve University, Cleveland, Ohio, investigated a curious disease m trout. In a trout hatchery many fish developed a swelling under their gills, fell off m condition and colour and frequently died. He found that m a series of tanks, fed by water which passed from the first to the second and so on down the series, the fish m the upper tanks were apparently healthy while down the series their condition was progressively worse. The swellings he found to be enlarged thyroids — goitres m nature. Now these fish were overcrowded and artificially fed and the tanks not properly cleaned. By thinning the fish, cleaning the tanks and increasing the water flow tho goitres diniin-

ished and the fish came back to normal — and McCarrison quotes this to prove his bacterial contamination of water theory. But a similar and more rapid improvement could be obtained if he added lodine to the water of the tanks.

One other illustration from animals will serve. Some years ago m certain states of America, notably Montana, N. and S. Dakota, Washington, Minnesota and Western Canada, it was noted that a large percentage of sows produced hairless and otherwise defective offspring, which were cither born dead or died shortly after birth. This malady was curie usly limited to certain parts of these states and even to certain parts of certain ranches, and was more prevalent at some times than others. Ihe adult pigs were healthy but the young were often very defective and all hael large thyroids, with active cells but poor m lodine content. Many things were investigated and amongst others the lodine content of the feed. Ihis was evidently slightly below that obtaining m unaffected districts anel acting on this lodine was administered to the pregnant sows. In carefully controlled experiments it was shown that these sows produced healthy, active progeny as compared with that of the untreated sows. An int cresting fact observed by Fenger m Chicago is that, m the thyroids obtained from animals from all parts of America and examined m Chicago where thyroid extract is made commercially on a large scale, the size of the thyroids and the lodine content show a seasonal variation. This is to be contrasted with the findings of Martin m Great Britain where the thyroids of the animals examined were uniformly small and varied little m lodine content which was high. In Britain this type of foetal athyrosis, or mai development, is practically unknown. Incidentally, except m certain areas, goitre m humaris is not general.

Now, you say all this is very interesting — or very boring — but what has it to do with the title as given on the report. In answer I ask you to look with the seeing eye at the necks of the girls and women you meet m the streets of Dunedin, or, for that matter, almost any town m the Dominion. When I came here 2| years ago the first thing that struck me was the prevalence of goitre m women, I found myself anxiously regarding the necks — amply displayed — of all the

women folk, and without exaggeration I feel safe m saying that at least 1 m 10 showed a thick neck. I was told, 'Oh yes, but that is physiological!' If so, the physiology of the females here is something different from those m Britain. Very soon I was satisfied that it was a pathological problem on a large scale that was occurring, and every day strengthens that belief. The condition is so common here that it is regarded lightly or unnoticed. In the pathological museum I found specimens of two fish taken from the Acclimatisation Society's hatcheries at Opoho m 1891 and 1892, which both show goitres such as Marine describes.

The other day I happened to be lecturing to my class on this very subject of goitre and I referred to the American piglets. At the end of the lecture a student came up and asked me the dose of lodine that had been given to the sows, as recently a very similar condition had occurred amongst sheep on a farm some way south of Dunedin. That is the first instance I have heard of m N.Z. of this deficiency disease amongst sheep, but I have little doubt there are other instances which will come to light m due course. I have perhaps m some measure justified the title of this Address with regard to animals m N.Z. but what about the humans? In this connection certain questions at once arise — (1) Why are women especially affected? (2) Why are not all women affected? (3) Is the offspring likely to suffer? In answer to the first, women ask more of their thyroids, especially at certain times such as pregnancy, and the gland responds normally or abnormally, depending on its supply of raw material which may be deficient, or altered by various factors. The first abnormal response is the beginning of a goitre. (2) Only a proportion, but a large proportion of women are affected because individual conditions vary considerably and probably here we are dealing with a relative and not an absolute deficiency or disturbance. (3) The offspring is undoubtedly affected, directly or indirectly, by anything interfering with the health of the mother. The exact amount of damage to the future generation m N.Z. by this prevalence of goitre cannot as yet be estimated, for we have not the data as yet, but judging by analogy the possibility of deterioration is great.

Suggestions. — What is one to suggest to combat this menace? The first thing is accurate observation and research on the data available here, but from the extensive researches mainly m America the basic fact seems to stand out that we are suffering from a wide-spread deficiency disease, a deficiency primarily of lodine — whether m its mode of intake or mode of utilisation m the body I cannot tell you. Acting on this assumption, Marine, who has done so much of the fundamental work on goitre, recently examined the necks of some thousands of school girls m the goiterous districts around the Great Lakes and he found over 50 per cent, with goitre. He gave courses of lodine to both normal and goiterous children and found, as compared with controls, that the condition was prevented or arrested. So far these observations are merely experimental, but they are very suggestive.

But clearly understand that this experimental administration of lodine is a preventative measure for arresting the goitre at its initial stages. When it is fully developed lodine may be a harmful drug and m any case the time is probably past when it can be of any use.

Whether the result of investigation into goitre will show that a more hygienic mode of life is all that is required for avoidance of this goitre, or that some deficiency, such as I have indicated, exists m the food intake, can only be decided by carrying through the investigation. A priori, one would be inclined to think that something more than hygienic measures are required m N.Z., for here the conditions are similar, but generally better than those m the Old Country, while goitre is infinitely more common here.

The motto of this Society is "To help the Mothers and save the Babies." How well it is living up to that motto all the world now knows and your Report gives some idea of the immense benefit that is resulting m all countries from the principles and practice initiated here m Dunedin. Its aim is to give the children the best possible start, and, so far as it goes, it succeeds admirably. But more is required. We here m N.Z. are too prone to take knowledge second hand and try to apply it to our conditions without first investigating these conditions. We have here a virgin soil for research m many directions, and if wo are to advance we must probe our problems

first hand, aided certainly by the knowledge gained from other lands. This Society deals with the mother and the babies, but what of the babies till they become mothers? What of the growing children, the young adults, and even the mere men? To restrict the matter to the subject m hand, viz., goitre, we have here an excellent opportunity for combined effort.

This Society had its birth m this academic city of Dunedin, and so also the only Medical School of the Dominion arose and is growing here. It is popularly regarded as primarily an institution for instructing students m the art of curing disease. It ought to be the centre of original investigation into the particular N.Z. problems of health and disease. In conjunction with the Health Department it should strive to show how illness may be prevented, not merely how the damaged may be patched. Do not think I am raising counter claims to this Society. Far from it. The good work of the Society is complementary to that of the Medical School. They should work m unison and mutually help each other, and both are deserving of the most ample support.

To carry on such investigations as are requisite, workers, time to work, and funds are needed, and needed on a large scale. That is where America scores. She recognises the need and her Government and millionaires supply the ammunition; the gunners m the form of scientific workers are thus enabled to keep on firing till the enemy is demolished. We should and can do likewise if only we recognise the need for such expenditure of energy and money. With certain notable 'exceptions neither has been much m evidence up till now, but that is not altogether the fault of either the

people or the Government, the need, until recently, has not been properly recognised or concretely presented by the medical profession to the people. I speak here only of medical problems.

If a few cattle become infected with ticks — the potential carriers of certain diseases — the farmers, the agricultural department, and the Government are up m arms at once to extinguish the unfortunate parasites. If a wool store is to be built, money is poured out by the £10,000. If hydro-electric energy is required, a million or two, to go on with, is gladly voted by the Government. And all these are right and for the good of the country. Their need is understood and financial profit is likely to result; and people can grasp such concrete things.

But, if some tens of thousands of women are affected with goitre, each an actual or potential cause of illness, with consequent inefficiencyand loss of energy, all a potential menace to the well-being of the next generation, it doesn't matter. Why waste time or money on such a vague matter! Let us abolish alcohol and all will be well!

And we call this a progressive country! God's own country I believe it is termed! Ladies and Gentlemen, the Lord helps those who help themselves. Surely health comes first, and health means primarily the prevention of illness, and any Society, any work, any investigation that is necessary to safeguard or improve health ought to come first and ought to be fully and amply supported. The immediate financial return may be a minus quantity but the future gain to the people will more than repay all that is spent."