Goiter

At the Congress of American Physicians & Surgeons in Washington last fortnight and at the American Association for the Study of Goiter in Memphis last week, staff men from the great medical clinics remarked dolefully about the falling off of business, especially goiter business. Not enough patients are going to the Mayos, the Criles, the Laheys to keep the plants running at efficient capacity. Doctors have had to be discharged, forced into envious private practice. Brothers William James and Charles Horace Mayo are easing the transition for their discharged men by giving each a home and a year's salary.

The Mayos, expert medical economists, do not agree with the run of the profession that Depression alone explains the lessened incidence of goiter. Like Dr. George Washington Crile in Cleveland and Dr. Frank Howard Lahey in Boston, the Mayos built a large portion of their clinic activities on goiter operations. Dr. Henry Stanley Flummer of the Mayo staff was the outgoing president of the American Association for the Study of Goiter last week. Dr. "Charlie" Mayo was on the program for a dissertation on thyroid deficiency, a commonly unrecognized disorder. Their interest in goiter has forced the Mayos to investigate the real causes for the falling off of their goiter business. They had a goiter survey made of Minnesota. There were actually fewer goiters in that goitrous State than any prior survey had shown. To the astonished surveyors it did not seem possible that Minnesota goiters had been operated or medicated out of existence. Unless depressed and worried existence prevented goiters, it seemed probable that five, ten years ago the State and the nation were in a goiter epidemic. If so, the epidemic now seems passed.

The florescence and subsidence of goiter is only one of the many unknown facts about the subject. At Memphis last week two dozen men read papers about goiter--from Dr. George Everett Beilby (Albany) on "Toxic Diffuse Goiter in Children" to Dr. Samuel James Waterworth (Clearfield, Pa.) on "Pre-and Post-Operative Treatment of the Plus-Four Bad Risk Goiter Case."

Goiter is fundamentally a thyroid enlargement. To the thyroid function cheery Dr. Crile has tried to apply his electronic theory of life (TIME, Dec. 5. et ante), a theory to which his colleagues listen with aseptic indulgence. Said Dr. Crile in Memphis: "What we eat is radiation. Our food is so much quanta of energy, not in that inert word calories, but quanta. The sun shines upon our food products, and the sun shines secondarily within us. in the body's protoplasm. Energy contained in food is put there by the sun's radiation on the atoms of plants. Atoms are the vehicles that are filled with solar radiance as so many coiled springs. These countless atomfuls of energy are taken in as food. This life-sustaining radiation releases electrical currents for the body's electrical circuit or nervous system. Once in us, these tense vehicles, the atoms, are discharged in our protoplasm, the radiance furnishing new chemical energy, new electric currents. So what we eat is quanta of radiation and currents of action."

Thought, according to this Crile theory, is a manifestation of short-wave radiation with the brain as the commanding centre of the body's electrical energy. The thyroid and adrenal glands govern the rate of radiation in the body. The adrenal glands produce the short, sudden energy of an outburst of temper, anger or rage. The thyroid gland controls the steady, long-time radiation necessary to the body's growth and performance. "Freed electrons charge up the cells; charged up cells cause muscle tone or muscle energy in nerve cells, such as the brain. Thus emotional and nerve activity is created."

No other theory of thyroid action or goiter cause had thorough, assured adherence at Memphis last week. Speakers still felt obliged to define terms meticulously. The thyroid is a double-lobed ductless gland in the neck, which ancients compared to a shield. (Greek thyreos means shield, and the word is properly thyreoid.) But the thyroid spans the windpipe more like a pair of saddle bags. In most people the lobes can be seen as gentle swells along the sides of the neck above the collar bone. The thyroid increases in size normally and temporarily in boys and girls at puberty, in women during menstruation and lactation.

Specialists generally call off three kinds of goiter--simple, adenomatous, exophthalmic.

Simple goiter, which is the commonplace type, may be transient. It is closely tied up with lack of iodine in the system. Dr. David Marine proved this by feeding Akron school children iodine twice a year from 1916 to 1919 and practically eliminating goiter from that bedeviled community. Most specialists work on the assumption that, for deficiency of iodine, the starved thyroid must work extra hard and grow bigger. On the other hand. Colonel Robert McCarrison from evidence he gathered in the Punjab is certain that germs in drinking water indirectly cause goiter. Iodine in drink or food, he believes, kills such germs in the intestines.

Theorists suggest that the present low incidence of goiters in the U. S. which the Mayos and other clinicians note, may be the result of the goiter scare last decade and the resulting exploitation of iodized salt. South Carolina, proud of its freedom from goiter, calls itself the "Iodine State," and thus labels its motor license plates.

Adenomatous goiters seem to be the result of alternate enlargements and shrinkings of parts of the thyroid.

Exophthalmic goiter is the most thunderous of the goiters. The thyroid enlarges, the eyes pop, the heart races, the nerves go atwitter. "It is," cries Professor William Boyd to his pathology classes in the University of Manitoba (Winnipeg), "as if some blast were blowing on the furnace of the body, fanning it into a condition of furious activity. . . . The disease is more or less self-limited. The fire burns itself out. . . . Many of the vital organs, particularly the heart, have been permanently damaged, and the patient is merely a wreck, and a permanent wreck."

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