NATIONAL LIBRARY OF MEDICINE Bethesda, Maryland MEMOIR "A. CONCERNING THE DISEASE of GOITRE, AS IT PREVAILS DIFFERENT PARTS NORTH-AMERICA, ^ By BENJAMIN SMITH BARTON, M. D. PROFESSOR OF MATERIA MEDICA, NATURAL HISTORY AND BOTANY, IN THE UNIVERSITY OF PENNSYLVANIA, AND ONE OF THE PHYSICIANS TO THE PENNSYLVANIA HOSPITAL. —^»*<^— " I know but one clafs of people who neTer err; thofe who do nothing, obferve nothing, and make no experiments." Eontana. PHILADELPHIA: PRINTED, FOR THE AUTHOR, BY WAY & GROFF, . No. 48, North Third-Street. l800. COPY-RIGHT SECURED. TO JOHN FREDERICK BLUMENBACH, M. D. F. R. S, PROFESSOR OF MEDICINE, IN ORDINARY, IN THE UNIVERSITY OF GOTTINGEN, \fc.Vc. —^►^<^~* Dear Sir, X CANNOT fuppofe the fubject of the following Memoir uninterefting to any perfon engaged in practical or phyfiological medicine. It mult, how- ever, be peculiarly interefting to a phyfician who has, for many years, cultivated the great fcience of Phyfiology with fo much attention and fuccefs as you have done. As the difeafe of Goitre is extremely common in fome parts of Germany, and in other parts of Eu- rope, the philofophical phyficians of thofe countries will not deem it an incurious point to examine, with attention, what affinity there is between the foil, the climates, and expofure of the European diflri£ts in which this difeafe prevails, and the foil, the climates, and expofure of thofe countries of America in which it alfo prevails. If the facts contained in my memoir mould ferve to throw any light upon the nature of this complaint, I (hall think the time which I have employed in the inveftigation has not been altoge- ther mifapplied. ( iv ) Permit mc to add, that from your corrcfpoml- cncc, and from your valuable writings, I have de- rived much pleafure and Improvement, efpccially in the inveftigation of one very intcrefting and dif- ficult queflion : I mean the natural hiftory of the phyfical differences among the various families of mankind. Your late publication* on this fubject is replete with ingenuity, and with various and ex- tenfive learning. My refearches (part of which will fliortly be publiflied) relative to this queflion, will, perhaps, have little to recommend them to the notice of fuch writers as yourfelf, and our com- mon friend Pro fell or Zimmermann, except the cir- cumflance of my having examined fome of the molt interesting of the human varieties, and thofe too, by moft authors, more imperfectly depicted than the reft, in the very countries in which they exift. That you may long continue to cultivate the fciences of Phyfiology and Natural Hiftory, with the fame zeal, patience, and fuccefs, with which you have hitherto cultivated them, Is the fincere wifh of, Dear Sir, Your friend, and humble fervant, &c. BENJAMIN SMITH BARTON. Philadelphia, December 8th, 1799. • re Generis Human! Varietate Nativa. E— IN a vilit which I paid to the Oneida-Indians, who are fettled at Oneida*, in the ftate of New- York, in the beginning of Auguft, 1797, I ob- ferved that an old woman, the wife of the principal chief of the nation, had a confiderable goitrous tu- mour, principally on the anterior part of her neck. The old man, her hufband, informed me, that this complaint is not uncommon among the Indians (Oneidas), and alfo among the Dutch fettlers. This was a clue to farther inquiries on the fubje£t, which I did not neglect to attend to, in the courfe of a very interefting journey which I had under- taken for the recovery of my health, and for the collection of materials for the natural hiftory of the United-States. Soon after I had received the information from the old Indian, I had an opportunity of feeing a • The village of Oneida, commonly called the Oneida-Caftle, u fitu- 2tcd on the Oneida-creek, which runs into the Oneida-lake, about twenty- one miles nearly fouth-weft of Old-Fort-Schuylcr, which laft place it about i.intty-fix miles, nearly north-weft by weft, from Albany. ( 7 ) newly-married and very young Indian woman, of the fame nation, who was deformed by a similar fwelling. I was informed, that this young woman's fifter laboured under the complaint to fo great a degree, that, at times, it much impeded her refpi- ration. In my return to the village of Old-Fort- Schuyler, on the Mohock-river, I had farther oppor- tunities of obtaining information concerning this difeafe. Lodging at a village of Indians, called the Brother-town-Indians, about fourteen miles from Oneida, I faw fome cafes of the complaint, and found that in this place feveral of the Indians were affected with it. Here I met with a young phyfician, who in- formed me, that the goitre is a common complaint in this part of the ftate of New-York. He faid, he had known the difeafe to appear among fome people from Connecticut, foon after their arrival in this part of the country. He even affured me, that fome of the fettlers from New-England had returned to that country again, alarmed at the appearance and progrefs of the difeafe in the new countries to which they had moved their families, I have faid, that the difeafe is not unknown among the Dutch inhabitants of New-York. I have lately been informed, that it is not uncommon C 8 ) at Fort-Herkemev, on the German Mats, fixteen or eighteen miles nearly fouth-eaft of Old-Fort- Schuyler. It is alfo frequent at Fort-Dayton ; and at a village, called Hcnderfon-town, about fevcn miles fouth of Fort-Herkemer. Some of the mofl remarkable cafes of the dif- eafe are in a Dutch family which lives upon the north fide of the Mohock river, immediately oppo- fite to Old-Fort-Schuyler. This family confifts of a father, a mother, and four or five children. Every one of them is afflicted with the goitre. The fwellings occafion fome of them to look hide- ous. This family removed from the river below this, to the place where they now* dwell, about fifteen years ago, at which time they had nothing of the difeafe among them. In the courfe of my journey from Old-Fort- Schuyler, fouth-weftward, to the Cayuga-Lake, a diftance of about eighty miles, I had an opportunity of acquiring farther information concerning the difeafe, which in fome parts of the country is known by the name of the " Swelled Neck." In al- moft the whole of this tract of country, the goitre prevails to fuch a degree, that every adult I met * In 1797, dice which time I have heard nothing farther concerning •!'.!. unfortunate family. ( 9 ) with was acquainted with the circumflance of Its existence, and was capable of giving me fome in- formation about it*. The goitre is very common In the Military Tract of New-York. As far as I can learn, it prevails to the greatefl degree in the town/hip of Manliusf. It is alfo very common in the Onondago-Valley, as in the neighbourhood of the Onondago-Salt-Springs, &c. In this part of the country, it affects both Indians and Whites. I fhall afterwards have occa- fion to mention fome other parts of the ftate of New-York, in which this difeafe prevails. The goitre of the ftate of New-York affumes very different appearances, in different perfons. In many, it feems to be merely an enlargement of the column of the neck, without any very evidently circumfcribed tumour immediately in the region of the thyroid gland. In others, the whole anterior part of the neck is evidently fwelled, and protube- * On the 8th of Auguft, on my way to the Jeniffeia-country, having alighted at the houfe of one Clock, fix miles fouth-weft of Oneida, I faw an old (white) woman, who had a confiderable goitre. She informed me, that there were feveral perfons, in the neighbourhood, who had the- fame complaint, and that, among others, her grand-fon's wife had it. I am induced to be thus particular, that future travellers, through this pari; of the country, may know where to look for the difeafe. f In the county of Onondago. B ( >o ) rant. In fome, the protuberance hangs down like an enormous wen, and in others, again, it allumes the appearance of a pear, hanging from, or attach- ed to, the throat. I obferved no inflances of this laft kind, but I am affured that they are not un- common among the females at Henderfon-town, fouth of the Mohock-river, where a particular mode of drefs is frequently made ufe of to fcreen the defor- mity from common or inquifitive view. This difeafe makes its appearance in perfons at various periods of life. Even infants at the breaft are n ot exempted from it. But I believe, fuch cafes are rave. The complaint is, certainly, much more com- mon among adults. Along the Mohock-river, it is faid to be principally confined to adults. Perfons re- moving into the country, where it prevails, have been attacked with it, even at a very advanced age in life. From all my inquiries concerning the goitre of New-York, I think there can be little doubt, that females are much more liable to it than males. I faw feveral females but not one male affected with it. At Brother-town, where there are a good ma- ny cafes of it, it is principally confined to the f jinale-fex. A country phyfician, refiding in this neighbourhood, remarked that the complaint is more common among females than males. In Manlius, and in other parts of the Military Tract, ( » ) where the difeafe is very frequent, I was conftantly informed, that women much more than men are affected with it. At Fort-Herkemer, Fort-Dayton, and at Henderfon-town, already mentioned, the dif- eafe is more common among females than among males, and is faid to be principally confined to adults. An intelligent friend of mine, Mr. James Geddis*, who resides at Onondago, informs me, that he cannot learn that it ever affefts men in that part of the country. We fhall afterwards fee, that at Pittfburgh, and in fome other parts of Pennsylva- nia, it is more common among females than among males. These facts are calculated to fhew the intimate relation of the goitre of our country and the fame difeafe as it has been obferved in Europe, and in other parts of the world. It is admitted, that the Bronchocele Botium affects women more than men ; and we have feen that Pafta has endeavour- ed to explain the caufe of this circumftance.t All the writers on the goitre of Europe} have obferved, that it is lefs frequent among men than among wo- men. In Boutan, according to Mr. Saunders, the * « From all the accounts I can get from the Cohofs-country in Con- necticut, where this diforder prevails, and all my obfervations here (at Onondago), I cannot learn that it ever affe&s men." Letter to me, dated Onondago-lake, November 16th, I79&- f See page z. | Coxe, Gautieri, Fodere, &c. &c. ( I* ) cafe is the fame*. I am inclined to think, that of a given number of goitrous perfons in the old and in the new world, the proportion of females in the latter is much greater than In the former. But I ought to be fenfible, that we are not yet prepared to make a calculation of this kind. Even in Eu- rope, and in the other countries of the old world, our materials for fuch a calculation are too imper- fect. But in America, they are peculiarly deficient. We are certain, meanwhile, that in both portions of the globe, the difeafe, in this refpect, preferves a common feature: females efpecially are its vic- tims. The goitre of the ftate of New-York is not confined to the human kind. In that part of the Military Tract which is called Manlius, I was allured that both fheep and young calves are fometimes affected with large fwellings of their necks. A calf, which had been weaned about three weeks, and fuffered to run loofe, after drinking the water of a certain ftream, became greatly affected with a fwelling of the neck. The animal was foon killed, fo that it is not known how mur'i farther the dif- * Philofophical Tranfactions, for tlie year 1789. Part Firft. M An thofe x Mr. Saunders obferves) who labour moft, and are the leaft protcded from the changes of weather, are moft fubject to the difeafe, we univcrfal- ly find it in Boutan more commoi. with t!.:. women than men." C >3 ) eafe might have proceeded. About three or four miles to the eaft of Onondago, there is a brook , the waters of which are faid to occafion great fwel- lings of the necks of men, of women, and even of fheep. The water of this brook is, certainly, highly impregnated with lime-stone, to which the mifchief is afcribed. In this country, it is custom- ary to turn out the fheep to graze upon the Beech and Maple lands, that is, lands whofe principal large vegetables or timber are the Beech*, and different kinds of Maplef. The fheep, being thus fet at liberty, have an opportunity of going to the brook which I have mentioned, where great num- bers of them, it is fuppofed from drinking the wa- ter, become afflicted with large fwellings of their necks. Thefe fwellings have not, hitherto, been obferved to be attended with much inconvenience to the fheep, and it is worthy of obfervation, that in the winter-feafon, they fubfide, or leave them. I was informed, that neither horfes nor cows have / been obferved to be affected with fimilar fwellings, from this or other brooks. But Mr. James Geddis, whom I have already mentioned, has lately affured me, that both fheep and horned cattle are fubject to this difeafe. " It is apt, he fays, to be fatal to calves and lambs." " In Manlius, fays the fame * Fagus ferruginea of Aiton, f Acer faccharinum, or Sugar-Maple, &c ( U ) gentleman, I have lately feen a fheep with a very large neck. She was fatting for the butcher, as fhe had always loft her lambs by this diforder*." It is not a new obfervation, that other animals, betide* the human kind, are afflicted with the dif- eafe of goitre. Mr. Coxe informs us, that in fome parts of Switzerland, even the dogs are fubject to " goitrous tumours," as he calls themf. I wish it were in my power to afcertain, with abfolute certainty, the actual extent of country in which this difeafe prevails. If this could be done, it would be a matter of much importance. It would enable us to fpeculate with more confidence concerning its origin, or caufc. Knowing the limits of the difeafe, it would principally be ne- ceffary to afcertain, what are the peculiarities in the climate, the foil, and the waters of the coun- try. But we have, as yet, afcertained little on this fubject except the exiilence of the difeafe. Almoft every thing valuable refpecting it remains to be difcovered. I have given the hint. I am anxious • Letter to me, dated Onondago-lake, November 16th, 1798. 4 Trav,_U in Switzerland, in a Series of S.ctt.ri to William T.Llmoth, S4. Vol. I, p. 349. Dublin: 1789. oaavo. ( >5 ) that it fhould be purfued by thofe who enjoy more extensive opportunities of obferving the difeafe. In the meanwhile, it may not be altogether ufe- lefs to give a rude view of the range of the goitre in the ftate of New-York. I mean its range from eaft to weft. Of its extent from north to fouth I can fay nothing that deferves attention. I find the difeafe in the vicinity of Old-Fort- Schuyler, about twenty miles from the head of the Mohock-River. Here, indeed, we obferve fome of the worst cafes of it*. It is not uncommon at Fort-Herkemer, on the German-Flats; at Fort- Dayton ; and at Henderfon-town, as already men- tioned. I am affured, that it has never been feen quite as low down the Mohock as the Little-Falls i of this river, about fifty-fix miles weft of Albany. It is unknown at Schenectady, except by name. From this view of the fubject, we may, per- haps, for the prefent, fix upon the Little-Falls of the Mohock, as the utmost limit, towards the eaft (I mean along the river), of this difeafe. From the vici- nity of the Falls to the village of Old-Fort-Schuyler, it appears to prevail more or lefs ; and from this place, weftward and fouth-weft ward, through a confider- * See page 8. ( 16 ) able extent of country, as at Brother-town, Onei- da, Canafaraga*, Onondago, and in other parts of the military diftrict, to within a few miles of the eaftern banks of the Cayuga-Lake. At Geneva, which is fituateJ on the banks of the Canada-Saga, or Seneca-Lake, I could not find that any inftances of the goitre have been ob- ferved. A phyficianf, who refides in this town, knew nothing of the complaint: nor has it, to my knowledge, been obferved in any part of the country immediately adjacent to the lake. I did not hear of the difeafe in my proerefs, weftward, through the Jeniffeia-country. But an Indian, of the Wunaumeeh tribe, has informed me, that he has feen feveral cafes of it among the Seneca and other Indians, who inhabit the rich flats along the banks of the Jeniffeia-river. I think I can depend upon the information of this Indian, who is an intelligent man. From the Jeniffeia, weftwardly, to the out- let of lake Erie, the country is, in a great meafure, a wildernefs, being inhabited, or rather wandered over, by a few Indian families. Of courfe, it is not eafy to fay, whether this latter diftrict contains much of the materials of the difeafe. This will be af- * Canafaraga is a fmall Indian village, about thirty-two miles, fouth- t. eft, from Old-Fort-Schuyler, and eievui miles, fouth-weft, from Oneida. f Dr. Goodwin. ( '7 ) certained in the future population of the country. Meanwhile, I fhall obferve, that there are fome cafes of goitre among the Tufcaroras, who are fettled near the utmofl weftern verge of New-York, about ten miles from the Falls of Niagara. Thus, we are already in poffeffion of facts which evidently fhow, that the difeafe of goitre has an ex- tenfive range in the ftate of New-York. Future inquiries will, I doubt not, difcover the difeafe in many other parts of this country, in which I have neither feen nor heard of it. I have already hinted, and fhall now proceed to fhow, that it is not ex- clusively confined to the ftate of New-York, but that it is a common complaint in various other parts of our continent. Cases of the goitre have been obferved in differ- ent parts of Lower-Canada, particularly in the low and marfhy grounds, between St. John's and Mont- real. The difeafe is alfo known in the ftate of New- Hampfhire, on the Connecticut-river. In this part of the country, as well as in New-York, it is called the " fwelled neck." It is faid to be much lefs common now than It was twenty or twenty- two years ago. C ( '8 ) A crNTiEM.w, whom I met with in my journey through New-York, informed me, that the goitre is not uncommon in the county of Bennington, and ftate of Vermont*. Mr. James Geddis informs me, that this difor- uer " prevails'' in the Cohofs-country, in Connec- ticut, where, from all he can learn, it never affects menf. We are in poffeflion of more information con- cerning the exiftence of the goitre within the limits of Pennfylvania. Having been informed that this difeafe has been obferved at Pittlburgh, and in other parts of the weftern country, I wrote to my friend Dr. George Stevenfon, of Pittlburgh, on the fub- ject. I here give a part of the information which he has communicated to mej. " Cases of goitre are met with among the in- habitants on the waters of the Allegheny and French-Creek, and at Sandufky; a few inftances on Monongahela, and at this place, where, out of 1400 inhabitants, there are not lefs than 150 per- fons who have it. • This county U fituated in the fouth-weft comer of Vermont, where it borders oo the ftate of New-York. t Letter to me, already referred to. Sec page u. Notc. 1 In a letter, dated 1'ittfburgh, January 4th, 1798. ( '9 ) " It is common to the natives and perfons lately fettled at thofe places, affecting both fexes, efpeci- ally females, and children even at the age of 18 months. " The fwelling appears on either fide of the neck, or in front; fometimes it is an uniform en- largement of the neck, evidently increafing in winter, and fometimes decreafing in fummer." It does not appear from Dr. Stevenfon's letter, that the difeafe has, in any inftances, arifen to a very troublefome or alarming height. The doctor, however, informs me, that fome of the patients are not unwilling to apply for relief, though little has, hitherto, been done for their benefit*. The goitre is extremely common among the inhabitants on French-Creek, one of the principal branches of the Allegheny-river. It is there al- mofl entirely confined to females. My very intelligent and worthy friend, Mr. John Heckewelder, informs me, that he has ob- ferved the goitre among the Indians, living on Big- » During the winter of 1796—1797, the late Dr. P------s vifited Pittlburgh. Several ladies, with fwelled necks, applied to him, and, it may be prefumed, that the metallick tra&ors had a very fair trial: but they would not fucceed in this complaint! C 20 1 Beaver-Creek, and on the rives Mufkingum*. It was principally confined to the " women and girls." " With iome, lays he, as they grew up, the com- plaint increaleil ; with others (efpccially where a remcdv was applied) it wore away again, though there are few that think much of it." In the fummer of 179;, " 1 faw, lays Mr. Ileekeweldcr, two women, whom I knew when girls at the age of ten or twelve years, and in whom this fvvelling haJ then begun ; now (1797) with fuch necks that "it furprized me. This fvvelling with one projected even before her chin. 1 afked one of them, whe- ther fhc had never made ufe of any remedy to cure her. She faid, fhe had applied burnt and powder- ed mufcle-fhclls, but to no effect. She felt no pain, fhe faid ; and was the mother of two children!." There are feveral cafe-; of the difeafe among . the Canadians who are fetlled at Detroit. It is principally confined to women, and is there thought to be owing to the drinking of the waters of the • Ei,:-Beavcr-Crcek, commonly called Big-I!< av< r, is a pr< tty torrfidt- rable branch of the Ohio, into which it truprie* itfclf, on the north fide, about twe-ntj -nine miles below Pittlburgh. Mufkingum is a more k.ii- Gdcr.ible Itruich, which falls into the Olii-., on the fame fide, a!,ou.t one hundred and fiity mile, below Pittlburgh. + Lcrre-- to rat, dated Btthlchcm, December id, 1797, arid January i.7l,i 7>8- ( 21 ) lakes. It is alfo known at St. Vincennes, on the river Wabafh, about one hundred and fifty miles above the entrance of this river into the Ohio. In the prefent very imperfect ftate of our know- ledge of the goitre of North-America, thefe few notices concerning the fpread of the difeafe through our country will not be deemed unacceptable to the curious reader. They will affift him in invefligat- ing the caufe of the difeafe, a fubject of great im- portance, to which I will now turn my attention. SECTION II. —<••<$►•>— Of the cause of the Goitre. —«$•>— IN entering upon this fubject, I think it proper to obferve, that wherever I travelled, in the ftate of New-York, the people to whom the difeafe was known, afcribed it to the water of the country*. I do not mention this as a proof that the water is, in any manner, concerned in the production of the * It is but juft to mention, in this place, that my friend, Mr. Geddis, thinks it " very problematical" that this difeafe is occalioned by the water. Letter to me. ( -- ) difeafe: for the great mafs of the people of a country are feldom remarkable for a talent of dif- covering the connection between phyfical caufes and effects. But this opinion is entitled to a care- ful examination ; becaufe feveral facts may be ad- duced in fupport of it ; and becaufe fome resecta- ble European philofophers have attributed the goitre of Europe to the drinking of water, impreg- nated with certain tcricfirial matters. The ingeni- ous Mr. De Lue, in particular, has efpouled this notion. He fays, that the waters that arc ufed by the people of the Alps, although to the eye they appear clear and pure, are neverthclefs highly im- pregnated with terreflrial matters. He imagines that thefe matters are circulated into the affected parts, where they obftruct the veffels, forming a kind of tophus, or cruft, and thus give rife to the difeafe*. Mr. Coxe, in his intercfting Travels in S-: fnrcad upon the fun ace, and is found to be the pre- vailing stratum at the depth to which wells, &c. arc tin;.;. 1 lie water of this county is, in general, of that kind which we call hard. It is fo ftrongly impregnated with limeftone, that it is common to find the wooden troughs, through which the water of meadows, &c. is conveyed, incrufted with the earth; and a fimikir incruftation is frequently found formed over the whole internal furface of the tea-kcttlcs \e. in which water has been boiled. In fome parts of the county of Dauphin*, par- ticularly in the neighbourhood of Harrilburgh, and along the Swatara above Middletown, there are imrncnfe collections of limeftone. At Bethle- hem, at Eafton, and other places in the countv of eNorthampton, the prevailing ftone is limeftone; «nd water impregnated with this earth is the com- mon drink of the inhabitants. But in none of thefe places is the difeafe of goitre feen. And here we fliould expect to find it, as the counties which I have juft mentioned are fome of the moft thickly fettled of any in the United-States. I do not affert, that thefe arguments are con- clufive in difproving the calcareous origin of goitre. But, I prcilmic, it will not be denied, that they " !:i PenEfylvania. ( 3' ) have their weight. On the one hand, we have feen, that there is little or no limeftone, or any other fpecies of calcareous earth, in feveral of thofe parts of our country where the goitre prevails. On the other hand, the goitre is entirely unknown in fome of the moft calcareous districts of America. Mr. Coxe obferves, that " although it appears that wherever there are goiters there is tuf-ftone; yet the reverfe is by no means true, that wherever the waters deposit tuf, there are always goiters. For perhaps the natives do not drink of the fprings which are loaded with tuf; or that fubftance is not fuffkiently diffolved in the waters ; abfolute folution being, perhaps, neceffary to produce thefe fwel- lings*." On this paffage, I fhall only obferve, that it is certain, that in many parts of the United- States, as in the county of Lancafter, there are no cafes of goitre, although the inhabitants do drink the waters, which hold in folution a confiderable quan- tity of calcareous earth, thefe American waters be- inrr, like thofe mentioned by Mr. Coxe, " as tranf- parent as cryftal." It remains for me to mention another argument in fupport of the notion that this difeafe owes its origin to calcareous earth. Mr. Coxe calls it " the * Travels, &c. Vol. I. p. 349- Not?- ( 3- ) ftrongeft proof, in favour of this opinion." *"■ A furgeon, whom I met at the Baths of Leuk, in- formed me, fays the traveller, that he had not un- frequently extraded concretions of tuf-ftone from feveral goiters; and that from one in particular, which fuppurated, he had taken feveral flat pieces, each about half an inch long. He added, that the fame fubftance is found in the ftomachs of cows, and in the goitrous tumours to which even the dogs of the country are fubject*." It is not neceffary to call in queftion the vera- city of this furgeon. Several very refpectable writers have found fimilar matters in the thyroid gland. Haller found cyfts enveloped with a firm cartilaginous covering, bony concretionsf, &c. Morgagni, to whofe invaluable work I muft refer the reader, who is defirous of obtaining a great deal of interefting information concerning the difeafes of this gland, funis up, in a few words, the experi- ence of various writers; " that moft of them met with hard bodies of a cartilaginous, bony, or ftony • Travels, &c. Vol. I. p. 349. f " Vidiin glandula thyreoidea cyftides, etiam cartilagineo velamentn firmatas, & effufum fabulum, uiiaa offea concrementa in glandula difperfa, parttiiiiiue glandular in pingirs lardi foeciem degenercm." Elcmcnta PhvGolrna: Corporis Hunuiii. Tomu* Tcrtius. j». 400. Laufmna, 1766. ( 33 ) nature, and fometimes even found the gland itfelf become bony, or of a ftony nature*." The existence of calcareous matters in the thy- roid gland of goiters does not appear to me to be a proof, that the difeafe which I am considering is, in any degree, owing to the drinking of water impregnated with this earth. Such matters are very frequently found in other parts of the bodies of perfons who, perhaps, had never been accuftomed to drinkcalcareous watersf. I may add, that Mr. Fodere did not find in any of the tumours which he exa- mined any thing like this earth. From the various facts and objections which I have stated, I am compelled to reject the fyftem which afcribes the difeafe of goitre to the ufe of water impregnated with calcareous earth. I mult confefs, however, that until I came to take a nearer and more minute view of the fubject, the fyftem did not appear to me an implausible one. Some of the facts related by Mr. Coxe feemed almost to car- * The Seats and Caufes of Difeafes inveftigated by Anatomy, &c. Vol, III. Letter L. Articles 30, 31, 32, 33, 34, 35, 36> and 37- Englifh tranflation. London, 1769, f Whilft I was a ftudent of medicine, in the Univerfity of Pennfylvania, I diffecled, at the anatomical theatre, the body of an old emaciated woman, whofe lungs were full of pieces of calcareous earth. Similar appearances have been difcovered by Morton, Curtius, Fernclius, Francus, Morgagni, and many other writers. See Appendix. E ( 34 ) ry conviction along with them,—as to the caufe of the difeafe in Europe. The facts mentioned to the traveller by the gentleman whofe goitre commonly increafed while he refided at Berne, and thofe men- tioned by Ceneral Pfiffer, are peculiarly linking*. Some of mv readers will not, therefore, be lur- prifed to learn, that I once adopted Mr. Coxe's notion, cfpecially when I found, that the waters of thofe parts of the ftate of New-York, in which I firft became acquainted with the goitre, are ftrongly impregnated with calcareous earth. But I now take my leave of this fyftem, and proceed to the confidcration of fome others, which have, at differ- ent times, been propofed by writers to account for the origin of the difeafe. — <■<•<< <4j.> ►>■> >— While it appears improbable to me, that calca- reous earth is the caufe of the goitre, I am even inclined to doubt, whether this complaint is, in any manner, occafioned by the drinking of the water or the countries in which it is obferved to prevail. Dr. Haller, before me, feems to have entertained a fimilar fkepticifm. The following are this great phyfiologift's words : " Nulla in Helvetia valJis eft, quae fuo rivo careat, nullus fere pagus, quern vivi aquarum fontes non ieddant laetiorcm. Vix noti * Sec pages 23 and 24. ( 35 ) putei, nifi paucifiimis locis, ubi nulla declivitas eft. Ouare neque credo ab aquarum vitio strumas nafci. Etfi enim in Valefia incolae lutofas aquas bibunt, Bernae tamen puriffimae funt, neque ideo ftrumae in utroque fexu infrequentes*." Thus it appears, that although the difeafe is known in Valais, where the inhabitants drink waters impregnated with terrestrial matters, it is alfo known, and not uncommon, at Berne, where the waters are very puref. I must not conceal, that the water of that part of the ftate of New-York in which I have obferved the goiter to prevail, befides holding in folution and diffufion a portion of calcareous earth, ap- peared to be otherwife very impure, and was cer- tainly unpleafant to the tafte. In the military townfhip of PompeyJ, the water is fo difagreeable, that many of the inhabitants have fuppofed it to be the caufe of a malignant bilious fever, called the * Alberti v. Haller Hiftoria Stirpium Indigenarum Helvetia Inchoata. Tomus Primus. Trsefatio, p. vi, vli. Bernx, 1768. Folio. ■f It is worthy of obfervatiori, that Dr. Haller and Mr. Coxe differ in their affertions refpeding the water of Berne. The firft of thefe writers afferts, thac it is very pure, whereas Mr. Coxe fays, that the pipes which convey water to the public fountains at Berne arc extremely charged with a calcareous fediment. Seepage 23. On this fubject, Mr. Coxe appears to have,been better informed than the great Swiis philofopher. \ In the county of Onondago. ( 3* ) " vellow water," which has carried off many of their horfes. 1 fu'bcct that a chemical analyfis of fome of thefe waters will fhow, that they hold in folution a confiderable portion of gypfum; wlullt others hold in diffufion a portion of fulphur. Both gvpfum and fulphur are very abundant in feveral parts of the ftate of New-York: the former, in particular, abounds in fome of thofe very parts of the country in which the goitre is a common com- plaint. The following fact, communicated to me by Dr. Steven Ion, will, perhaps, be thought to have fome weight in difproving the notion, that the goitre is owing to the water ufed as drink by the inhabitants. " Formerly the inhabitants of Pittlburgh drank the waters of the neighbouring rivers* : of late, well- water only is in ufe. The increafc of inhabitants confidercd, the difeafe i-> not more frequent than formerly!." —< <•< <<.$.>>>>>— The goitre has often been aferibed to the ufe of fnow-water, ufed as a drink. But there can be very little foundation for this idea, though it has teen fupporteu by feveral refpectable write:-. It is • The Allegheny and Monongahela. f Later to me, already referred to. ( 37 ) certain, at leaft, that the inhabitants of the ifland of Sumatra are greatly afflicted with this difeafe, and yet no fnow ever falls in that ifland. On the contrary, the difeafe has never been feen in Green- land, though in that inhofpitable portion of the earth, fnow-water is the common drink of the in- habitants. The refpectable Dr. Watfon obferves, that he never met with a cafe of the complaint, in the county of Westmoreland, in England, " where there are higher mountains and more fnow than in Derbyftiire, in which county the complaint is very common*." Linn^us tells us, that this difeafe is entirely unknown in Lapland, where, it is unneceffary to obferve, water in which fnow has been diffolved muft often, and very largely, be drunk. In his beautiful apostrophe on the happiness of the Lap- landers, the immortal Swede confiders their ex- emption from goitre, as one of their felicities. " Tuus potus, fays he, aqua crystalline pellucidi- tatis, quae nee cerebrum infania adficit, nee ftru- mas in Alpibus tuis producitf." * Chemical Eflays. Vol. II. p. 158. London, 1787. f Flora Lapponica. I quote the paffage from memory. Here I may obferve, that tuf, fuppofed by Mr. Coxe to produce goitre, is common in Lapland. Speaking of this fubftar.ee (the Tophus Ludus of Linnaus), the Swedifh naturalilt fays, " Habitat in littoribus fiu-oiorum glareofo-argillaceis Lapponiae, Dalekarliae, aliifque." Syftema Naturae, &c. Tomus III. p. 186. Vindobonae, 1770. See Appendix. ( 3« ) It would be caf; to adduce inftances of many other countries, the inhabitants of which drink fnow-water, although the difeafe of goitre is en- tirely unknown among them. But, perhaps, it is not neceflary to purfue the fubject any farther. Some other objections to this theory will, however, be taken notice of immediately. A late writer, Dr. Gautleri, confiders " expo- fure to cold, and the drinking of very cold water," as " a principal caufe" of the goitre. lie remarks, that all the waters ufed by the people of Stiria and Carinthia, who are fubject to this dif- eafe, " arc thofe which flow down the fides of the mountains, the tops of which being perpetually covered with fnow, render thofe streams of an ex- ceflive degree of coldnefs." Dr. Gautieri entirely rejects the bad qualities of the fnow-water as pro- ductive of this difeafe, " any further than as it operates by its coldnefs fimply*." Mr. George Forfter fays, that during his voyage round the world with Captain Cook, in the year • Tyroltnfium Carynthiorum, Styriorumque Struma. A Jofepho Gautieri, M. D. Obfcrvata et Defcripta. Vindobonx, 1794. I have not feen this work, and know nothing of it but what I learn from an analyfis of it in The Medical and Chirurgical Review, &c. Vol. I. p. 377----387. London: 1795. ( 39 ) 1773, the greater part of the crew having drunk of the water that was procured by melting ice, were affected " with fwellings in the glands of the throat." " Water (fays this ingenious writerj melted from fnow or ice, is known always to have this effed, and the constant ufe of it in moun- tainous countries produces thofe enormous wens (goitres) which are common among Alpine nati- ons." Forfter attributes the effects produced by the water to its having loft its fixed air*. My objections to the fyftems of Dr. Gautieri and Mr. Forfter may eafily be collected from what has already been faid. The difeafe is common in Sumatra, and fome other hot countries, where no fnow or ice water is ever feen. Mr. Forfter is, moreover, greatly miftaken in afferting, that water melted from fnow or ice is known " always" to pro- duce goitre ; for this difeafe is unknown in fome of thofe countries where, to ufe the words of Haller, an " aeterna glaciesf" prevails. These objections, then, are decifive. They moft plainly demonflrate, that neither fnow-water, nor any other water of an extreme degree of coldnefs, is the caufe of the difeafe. In addition to thefe facts, * A Voyage round the V-'orld, &c. Vol. I. p. 107, 108. London, 1777. 4to. f " iEternas glaciei moles." ( 40 ) I may remark, on the authority of Mr. Fodere, that it is obfervable, in Maurienne, that the goitre is entirelv unknown among the people who drink the water, near its fource, on the mountains, whereas it is common among thofe who drink the fame wa- ter as it flows downwards, and becomes more like fpring-water*. Mr. Fodere likewife remarks, that the goitrous tumour commonly increafes in fumnicr, and de- creafes in winter, efpecially if the weather, in this latter feafon, be dry inftead of moift*. This ob- fervation, which, certainly, goes fome way to prove, that the dileale is not occafioned by the drinking of cold water, is perfectly agreeable to one which I have already made, in a former part of this memoir; that the goitre of New-York has frequently been ob- I ferved to fubfide or leffen during the winter feafon ; and, in particular, that, at this time, the fwellings of the necks of fheep fubfide* or leave them}. • Effai, &c. \ See page 13. The qucftion concerning the increafc and decrc-fc of goitre, in cold or warm weather, is one of confequencc, and has not been fufficiently attended to. The coincidence between Mr. Fodcrc's obferva- tion and that of the people in the ftate of New-York is ftriking. I do not 6nd, that Dr. Gauti.ri, who afcribes fo much to the influence of cold air and very coM water, has faid any thing on the fubjed. Dr. Stevcnfon's remark muft not be forgotten. This gentleman {■„•/, (fee page 19), that the goi- tre at Pittlburgh " evidently" iucreafe, in wii.i.r, and " fometimcV de- creafes in fummer. ( 4i ) I do not, by thefe obfervations, mean to deny, that glandular fwellings are often induced by cold. This is a fad which is familiar to every phyfician. The fad related by Mr. Forfter, arid already quoted*, is a striking one. I have, more than once, expe- rienced, in the fummer-feafon, a considerable fwel- ling of the glands of my throat, a very fhort time after eating a pernicious luxury, which has come into very general ufe in our city. I mean ice-creams. But neither in this cafe, nor in the inftances related by Mr. Forfter, was there any evidence that the thyroid gland was efpecially, or at all, affeded. The fuel- ling (in my cafe, at least) appears to have been prin- cipally confined to the internal tonfils. ——<■<%>■■>•■— It is the opinion of fome perfons, with whom 1 have converfed on the fubjed, that the difeafe of goitre is occafioned by the drinking of water fup- plied by fprings near beds of foflil-coal. This the- ory has been the refult of very partial obfervation. The difeafe is common at Pittlburgh, where coal abounds. But there are many extenfive coal-coun- tries of America, in which this difeafe has not been obferved. I may fay the fame of Europe. On the contrary, the goitre has an extenfive range in * See page 39. F ( 42 ) that part of the ftate of New-York in which no coal has ever been difcovcrcd. ——•« «««♦*► ► »• ►■— Mr. Saunders, who has given fome account of the goitre of the country oi' Boutan, informs u.", that " on finding the vegetable productions of Bou- tan the fame as thofe of the Alps, in alinoft every inftanee, it occurred to him, that the difeafe might arife from an impregnation of the water by thefe plants, or the foil probably poffciling fimilar qual- ities, the fpontaneous produdions of both coun- tries, with very few exceptions, being fo nearly alike*." I could adduce but one argument (if indeed it were one), that the goitre of our country (I particularly mean of the ftate of New-York) is owing to an impregnation of the waters by certain vege- tables. It is this, that in that trad of the country where the goitre prevails, there are many of the plants of thofe alpine countries of Europe, in whieh the fame difeafe has been obferved. But on thi; fuhjed a general remark may be made: that as we approach the northern parts of our con- tinent we find a great many of the plants of northern Europe. this fad may feem to favour the notion which I have mentioned. But here I muft obftrve, • Phiiufo^L.-al Tra:J'-elioni, for the year 1789. Put ir\r'.\. ( 43 ) that we do not find the goitre in many of thofe parts of our country in which the botanift difcovers the plants of Europe, in the greatest abundance*. I do not know whether it is very important to obferve, that fome of our Indians imagine, that the goitre is produced by certain infeds inhabiting the water, which they drink. There was a time, during the reign of what might be called the Ani- malcular System, when a fad or notion fuch as this would have been greedily caught at by fome ingenious man; by a Bonomo, a Calvoli, or a Linnseus. A coarse and unwholefome food has been af- figned as one of the caufes of the goitre. Among other articles, chefnuts have been particularly ac- ^ cufed of favouring the difeafe. Dr. Gautieri remarks, that thefe nuts are produced in great plenty among the Tyrolefe (where the goitre is a common com- plaint), and are eaten by the poorer inhabitants, with great avidity. Children, he tells us, are ob- ferved, in fwarms, furrounding the trees, greedily devouring both the ripe and the unripe fruit. The natives make the nuts into puddings, which are very difagreeable to ftrangers, but are much relifhed * See Appendix. C 44 ) by the people thcmfelvcs*. " Hogs flefli U much fought after amongft them, but this is taken in fuch a dry, hardened, ftate that it can fcarcely afford wholefome nourillimcnt. They greedily devour the fat of the meat, and that without any condi- ment, not even fait, which might render its digef- tion more eafy. Thus the worft kind of food, and prepared in the worft manner, without any regard to cLanlinefs, the ufe of wine of a bad quality, and drinking fpirituous liquors to excels, afford ample caufe for a vitiation of the whole habitf." It is not, at all, improbable, that a coarfe, or rather unuholcfome, food may predifpofe the fyftem to goitre. But there is no reafon to fuppofc, that fuch food is capable of producing the difeafe. Whole nations of mankind fubfift upon a diet as crude and as unwholefome as that of the Tyrolefe, without ever experiencing the difeafe. On this fubjed Mr. Fodere' has favoured us with an obfervation, which is peculiarly ftriking. He tells us, that no food can be coarfer than that which is ufed by the peo- ple of the mountains, where the goitre is unknown, and noin richer and better than that of the rich of the cities in the vallies, who are nevertheless afllided with the difcafej. * See Arpcndix. f The M.di;al and Chirurgical Review, &c. p. 385, ;,?/>. i Effai, &c. ( 45 ) In our own country, there does not appear to be any neceffary or obvious connedion between the goitre and the nature of the food of thofe who labour under this complaint. For although the difeafe is not uncommon, in feveral parts of the country, among the Indians, who occasionally labour under a deficiency of good food, yet I do not know, that it is more common among thefe favages than among the whites (inhabiting the fame trad of country), who, purfuing the bufinefs of agriculture, have at all times an abundance of found and nourifhing ah\ ment. I may add, that the difeafe is entirely un- known among fome of thofe Indian tribes who more frequently labour under a fc.arcity of food than any of the other tribes of our continent. I proceed to the confideration of fome other fuppofed caufes of goitre. Dr. Gautieri is of opinion, that one of the " ex. citing" caufes of this difeafe is the cuftom which the common people have " of drawing carriages like cattle up the hills, which they do by cords placed over the fuperior part of the thorax. By the preffure they occafion, and by the frequent im- pediments to refpiration, the blood is prevented from returning with freedom by the jugular vein*." * The Medical and Chirurgical Review, &c. p. 386. ( 46 ) The opinion of Dr. Gautieri receives confidera- ble fupport from a fad communicated to me by Mr. Heckewelder. This gentleman, who has fccii a good many cafes of the goitre among the Indians, particularly the women and girls, in the weftern country, afcribes the complaint to the heavy bur- dens which they carry, " bearing all the weight they have on the back, by a band which is fixed at their forehead. I have taken notice, fays he, when it firft made its appearance in girls, which was never until they were employed in carrying burdens*. The men generally carry their burdens with a band fixed at their breaft, wherefore they are not fo fubject to this dileale. |" These facto are interefting. They feem to ren- der it highly probable, that the goitre, or at leaft fome fpecies of bronchocele, may be occafioned by fimple preffure, producing an impediment to a free and regular refpiration. Whether the difeafe thus produced be the true goitre, 1 will not pretend to determine. It is, moft probably, that fpecies of bronchocele which Sauvages, after Roncallus, calls Bronchocele ventofa J. Other caufes, confiderably fimilar to the one • See Appendix. J litter to me, dated Bethlehem, DcccMlx.r ad, 1797. S ee page I. ( 47 ) juft mentioned, have been afligned for the produc- tion of goitre, or a tumour of the thyroid gland. It was the opinion of Andreas Pafta, one of the pupils of Morgagni, that the reafon why women are more fubjed than men to the Bronchocele Bo- tium, is this, that a debility is induced in the thy- roid gland, in confequence of the frequent vomit- ings to which the fex is liable, during the period of their pregnancy*. Lalouette, a French writer, fays, that the thyroid gland is frequently affeded with aerial tumours, which he afcribes to the throes of women in labour. In this cafe, he imagines, that the air is forced from the trachea into the cel- lular texture of the gland. Haller, from whom I quote what I have juft faid, does not difpute the theory of Lalouette. The great phyfiologift informs us, that Theophilus de Bordeu inflated the thyroid gland from little orifices above, or immediately in, the firft ring of the bronchia, and by a very fmall dud ; and that he alfo introduced briftles through thefe paffagest- * See page a. f " Addi poteft, frequentes tumores aereos in glandula thyreoidea a nixu parturientium oriri, qui cellulofam telam diftendant, manifefto ar- gument, vias effc ex afpera arteria, per quas aer in thyreoideam glandulam exeat, eoque, & in laryngis ventriculos liquidum glandule per lymphatics vafa Iffundi poffe fufpicatur vir el. (Lalouette). Sunt denique fuper pri- mum bronchi anulum oftiola, aut in ipfo primo anulo, & minimus dudus, per quis vias Tbeopbilu: de Bordeu glandulam thyreoideam inflavit, & per qnas'fetas immifit." Elcmcnta Phyfiologix Corporis Humani. Tomus Tciti.-s. p. y)Z & yjj. C 48 ) Mr. Fodere- remarks, that during pregnancy, the goitre will ealily arife, often fuddenly, becom- ing painful, and feldom difappearing, unlefs due attention is paid to the complaint, particularly in a country or diftrid where it is endcniial. Our author does not doubt that, in thefe cafes, air is the caufe of the difeafe. This, he thinks, is proved by the fuddennefs of the fwellings, which often arife after paflions of the mind, when breathing, as well as in the cafe of pregnancy, is impeded. Tumours from thefe caufes are not, according to Mr. Fodere, exclufively confined to the thyroid gland, but alfo affed the neighbouring parts*. The theory of thefe aerial tumours of the thy- roid gland feems, at prefent, to be more eafy of ex- planation than formerly. Late inquiries appear to have more completely eftablifhed the fact, that there is an immediate communication between this gland and the larynx. Mr. Fodere blew air into a larynx, which had been well cleanfed, and foaked a while in water, and fecured by a ligature below. In con- fequence of this, the thyroid gland fwelled up. He alfo found, that on filling a larynx with fpirit of wine, the fmell of the liquor was plainly perceived in the thyroid gland*. • Eflai, &c. ( 49 ) SECTION III. —<■•«£>••>—^ Of the cause of the Goitre, continuedi _..<4>.._ THE learned and ingenious Mr. De Sauffure has propofed a new theory of the caufe of goitre and cretinifm*. This gentleman's inquiries fully convinced him, that the goitre is not occafioned by melted fnow or ice, nor by water impregnated with terrestrial matters, nor by drunkennefs, coarfe food, nor debauchery. After travelling along the greater part of the Alps, and direding his inquiries, with particular attention, to this interesting fubjed, he affures us, that he has not feen a fingle village fubjed to the difeafe, that was fituated at a greater height above the level of the fea than five hundred or fix hundred toifes ; that is, between three thou- fand two hundred, and three thoufand eight hundred and forty Englifh feet. He has never feen the difeafe in plains opened on all fides. He has ob- " Mr. De Sauflure treats of goitre and cretinifm, as the fame complaint. He allows, indeed, that many goitrous perfons are not cretins, but he fays, that all the cretins he has feen are affected with goitrc\ It is a cir- cumftance well calculated to fhow that the goitre and idiotifm arc not »tcrjfarily connecled with each other, that although the fwelled neck is a lommoii complaint in many parts of North-America, it is very rarely *\xi\ in connection with idiotifm. See Appendix. G C 50 ) ferved that it is common in the narrow vallies, and that it generally ceafes where the vallies terminating expand into open plains. He is, therefore, of opi- nion that the caufe of the complaint, is to be fought for in fome modification or condition which is ex- clufively confined to vallies but little elevated above the level of the fea. This modification, in the opinion of our author, is an heated and ftagnated air, owing to the confined fituation of the vallies. Some of the fads mentioned by Mr. De Sauflure, and other fads which I have colleded, give confi- dtrable weight to this theory. The Swifs philofo- phcr obferves, that generally, in pretty wide val- lies, where there are houfcs on both fides of the valley, thofe villages that are fituated on the fide the moft expofed to the fun, which receives his dired rays, and the heat refleded back from the rocks over them, are more fubjed to the difeafe than the villages which are expofed to the north. Thus, he obferves, that the village of Branfon*, which is fituated oppofite Martigny, contains a much greater number of cretins, becaufe it is fitu- ated to the fouth, at the foot of a rock, from which circumftances, it is more liable to be heated than Martigny. Mr. De Saussure is aware, that the heat alone * In the Valla!*. ( 5' ) of the fituation cannot be the fole caufe of the difeafe, fmce the plains of many fouthern countries affeded with a fuffocating heat are not fubjed to it. He imagines, that the air which is confined in the val- lies being much heated by the fun's beams, affumes a kind of corruption, the nature of which is not well underftood by us. This hot and vitiated air, principally affeds the tender fibres of children, producing that relaxation of the fyftem, which ap- pears to be a very general concomitant of the goitre and cretinifm of the vallies of Switzerland, and which, in the opinion of our author, is the caufe of the goitrous tumour, independently of any ob~ ftrudion of the thyroid gland*. It is a circumstance greatly in favour of Mr. De Sauffure's theory, that the goitre, in almost every part of the world, feems to prevail in the valley- fituationf. Thus, to confine my remarks, at pre- fent, to our own country, the difeafe is very com- mon in the Onondago-Valley, in the ftate of New- York. This is a narrow and unwholefome valley. It is not uncommon in the vallies of the county of Bennington, in Vermont; and we have feen, that it * Voyages dans les Alpes, &c. Par Horace-Be'ntdicT: De Sauffure, Profeffeur de Philofophie dans l'AcaJemiede Geneve. Tome II. p. 480, &c. A Neuchatel, 1779. f See Appendix. ( 5* ) is very common at Pittlburgh. The fituation of this laft place is very iimilar to that of many of thofe parts of the old-world in which the difeafe prevails. It is a vale, or perhaps rather bafon, entirely furrounded by hills, except at the three openings which are formed by the triangular junc- tion of the rivers Alleghaney and Monongahela. In other words, there is an opening, through the hiils, down the Ohio, and one up each of the two other rivers. The openings on the Ohio and Mo- nongahela are not greater than the breadth of the rivers. But that up the Allegheny is much more confidcrable, being near half a mile wide on each fide of the river, near two miles in length on the weft fide, and live miles at leaft on the eaft fide. The whole area of the bafon is about a mile and a half in diameter from north to fouth, and one mile from eaft to weft. The fouthern bank of the Mo- nongahela, on the fouth fide of the town, is a pretty confiderable hill f, fuppofed to be between fix and nine hundred feet high. The hills which furround the town, on the other fides, are more re- mote from it, broken more gradually into ridges, and Hoping more away J. f Called the Coal-Hill, from the vaft quantities of coal which it con- tains. See page 41. 1 I am indebted to Mr. Hugh Brackenridge for this particular account of the fituation of Pittlburgh. I take this opportunity of acknowledging my obUgations to that gentleman for hit kind attentions to the fubjed of ( 53 ) From this account, it is evident that the fituation of the town of Pittlburgh is rather a confined one, and perhaps favourable to that heat and stagnation of air which, in the opinion of Mr. De Sauffure, is efpecially concerned in the produdion of goitre and cretinifm. I wish it were in my power to give a particular account of the fituation of other parts of our coun- try in which the goitre prevails. But upon this fubjed, my colledion of fads is very fcanty. The topographical hiftory of the goitre muft be much more complete, before we can afcer- tain, with certainty, the caufe of the complaint. Meanwhile, the following fads deferve to be men- tioned. They, at leaft, fhow, that the goitre is not exclufively confined to vallies, or to mountain- ous countries. I have already obferved, that the goitre is a com- mon complaint in the Military Trad, and in other parts, of the ftate of New-York*. In this part of the country, it is often met with in situations by no means entitled to the appellation of vallies. It is not uncommon at Fort-Herkemer on the German- this memoir. 1 fhall afterwards have oceafion to avail myfelf of other information communicated to me by Mr. Brackenridge. * Seepages 6, 7. 8, 9, 14, 15, 16, 17, &<;. ( 54 1 Flats*, a beautiful plain, or large piece of well- opened land, which is confiderably elevated above the tide-water of the river Iludfon. The goitre is a common complaint in diffi rent parts of the country north-weft of the river Ohio, as upon the waters of Big-Beaver, IMwfkingum, Siotof, and at DetroitJ. In none of thefe places, has it been obferved to prevail in the vallies. In- deed, in the whole of the trad of country which I have juft mentioned, there are no mountains, or confiderable ridges fufficient to form vallies. I am acquainted with a good deal of the country that is watered by Big-Beaver. It is a flat or level coun- try, abounding in favannas, or natural meadows. The head-waters of this creek are, I think, confi- derably higher than the level of Lake-Erie. They are, certainly, fome hundred feet higher than the level of Lake-Ontario, near the fouthern border of which (I mean in the Onondago-Valley, on the ► See page 8. | Since the preceding pages were printed off, I have bun informed, that the goitre is a common complaint among the Shawnecs-lndians refiding on the Sioto, a confiderable river which empties itfelf into the Ohio, below the mouth of the Mufkingum. i I hive already obferved, that thurc are " feveral cafe, of the difeafe among the Canadians who are fettled at IV trr.it'' Seepage iO. I have fince been informed, that there are at leaft forty cafes of goitre at thi* place, and that it is wholly rcitrietcd to the Canadian,. ( 55 ) JenhTeia-river, &c.) the goitre prevails to a confi- derable degree. The Sioto is bordered with rich flats, or mea- dows. This river overflows in the fpring-feafon, and then fpreads about half a mile, though when it is confined within its banks it is fcarce a furlong wide*. Detroit is fituated upon an extenfive flat or level piece of ground, on the banks of the Strait of St. Clair. There are no mountains in the neigh- bourhood, or within fight. I have already faid, that the goitre has been obferved, " in the low and marfhy grounds, be- tween St. John's and Montreal!-" Thefe grounds are very fimilar to thofe on which Detroit is fitu- ated. They are belt known by the names of flats, and table-lands. Cafes of the difeafe have likewife been obferved, in the fame fituations, at different places along the banks of the St. Lawrence, between Montreal and Quebec. It is evident, from the fads which I have men- tioned, that the goitre of North-America is not * See Hutchins's Topographical Defcription of Virginia, Pennfyl- vania, Maryland, &c. &c. page a*. London: 1778. f See page 17. ( 56 ) exclufively confined to the vallies of this continent. On the contrary, it prevails, to a great degree, in fome of the high and level plains of the country, where there is no reafon to fufped that the air is in an Impure or ftagnated ftate, from confinement by mountains, or by hills. It alfo prevails in the flats, or intervale lands, along the margins cf fome of our rivers, where often the neighbouring hills are of a very inconfiderable height, and feem incapable of increasing the heat or impurity of the air. I may add, that this difeafe is altogether unknown In many of the vallies, both fuch as are more fpacious and thofe which are more narrow and alfo deeper, in various parts of North-America*. Upon the whole, I cannot adopt the theory of Mr. De Sauf- fure, though I am willing to allow that it is ingeni- oufly fupported, which, perhaps, is as much as can, in rigid propriety, be faid of any of the many theories that have been offered to account for the caufe of the goitre. In juftice, alfo, to this learned naturalift, I cannot help here obferving, that I am of opinion, that a more extenfive and critical inquiry into the topographical hiftory of the goitre will ferve to fhow, that a peculiar modification of the air (derived, I believe, principally from terreftrial exhalation) is fomehow eflentially concerned in the production of thk difeafe. Sec A j; endu, ( 57 ) I must not conclude this topographical view of the goitre of North-America without obferving, that the fads hitherto colleded feem to fhow, that, in general, this difeafe prevails to the greatest de- gree in the neighbourhood of the lakes of the coun- try, or about the firft fources of the rivers which arife near thefe lakes. Thus we find the goi- tre near thofe waters of the Mohock-river which take their rife near the lakes Ontario and Oneida. We find it at Oneida and at Onondago, near the waters of the fame lakes ; on the waters of French- creek, near Lake-Erie; and at Detroit between Lake- Huron and Erie. In this refped, as well as in many others, the American goitre bears a clofe affinity to the goitre of Europe. The difeafe is extremely com- mon in Switzerland, in the neighbourhood of the lakes of that country, or about the waters which empty themfelves into thofe lakes. It muft not, however, be forgotten, that the goitre prevails, in many parts of the world, at a great diftance from any lakes whatever. Thus, in our country, it is common at Pittlburgh, which is not in the neigh. bourhood of any of the lakes. I NOW proceed to offer my own opinion relative to the caufe of the goitre. On this fubjed, bow- ever, I fhall not take up much time: for the fads H ( 58 ) which I have colleded in fupport of my opinion are but few in number, and are not always afcertained with as much accuracy as I could wifh. In the prefent fcantinefs of corred information upon this fubjed, I fhould manifeft, were I pofitively to fay what is the caufe of the difeafe, but a fmall portion of that cautious forbearance which is, perhaps, too rarely found among theoretical phyficians, but which is of the higheft importance in the inveftigation of difficult medical queftions, fuch as that in which I am now engaged. As glandular affedions, of different kinds, are not unfrequent in countries in which intermittent fevers prevail, I was early led to conjedure, that the goitre might be occafioned by the fame matter, or matters, which induce thefe fevers. This fufpi- cion, I foon found, could be fupported by plaufible reafonings. Thofe very trads of New-York in which the goitre is moft common are extremely fubjed to intermittents, to remittents, and to dyfen- teries. But in the farther inveftigation of this queftion, I could not but difcover, that many other parts of our country are equally fubjed to thefe fevers, where, however, the difeafe of goitre is en- tirely unknown. This remark applies, with pecu- liar force, to moft of the Atlantic towns of the United-States. ( 59 ) It is not a new fufpicion, that the goitre is ow- ing to the agency of the fame caufes which induce intermittent and other fevers. Mr. De Sauffure has mentioned, and rejeded, this theory. " It is poffible, and even probable (fays this naturalist), that exhalations from marfhes, fituated at the bot- tom of fome vallies in which cretinifm prevails, may contribute to the produdion of this diforder: but I believe, it is rather owing to the heat which thefe exhalations render the air fufceptible of, and to the relaxation which they produce, than to the pu- trid miafmata arifing from the marfhes : for, I re- peat it, the countries of plains the moft afflided with marfhy vapours are fubject to fevers, and other grievous diforders, but no cretins are to be feen. And, on the other hand, we fee villages cruelly afflided with the cretinifm, without having any marfhes in their neighbourhood. Villeneuve d'A- ofte * is a flriking example of this truth f." On this quotation I fhall make an obfervation, which would, perhaps, have fome influence upon the mind of Mr. De Sauffure. " I repeat it, fays he, that the countries of plains the moft afflided with marfhy vapours, are fubjed to fevers, and to other grievous diforders, but no cretins are to be * See Appendix. f Voyages dans les Alpes, &c. Tome II. p. 486. ( 6° ) feen.,, This obfervation, perhaps, applies to tncfc countries of Europe, in which the Swifs philofo- pher made his remarks on this difeafe. But, it does not apply, with equal force, to the countries of North-America. On the contrary, the difeafe of goitre appears ic prevail, to a very remarkable degree, in fome of the great plains of our country, which are fubjed to intermittents, to remittents, and to dyfenteries. Indeed, fome of the very worft forms of thefe difeafes annually appear in alinoft the whole of that trad of country in which the goitre is fo common. Inftances in illuftration of this pofition will afterwards be mentioned. In the mean time, I fhall make a few remarks on the con- dition of fome of thofe European vallies in which goitre is a very common complaint. Mr. De Saussure allows that there are marfhes in fome of the vallies in which the goitre is found ; but he fuppofes that exhalations from thefe marfhes are no otherwife concerned in the produdion of the difeafe, than in as far as they render the air fufceptible of being more heated, or as they induce a relaxation of the fyftem. Mr. Fodere exprefsly fays, that the difeafe is moft common in the loweft vallies of the Alps, where the houfes, furround- cd with many broad-leaved and very fhady trees, are fituated in the neighbourhood of brooks, ( 61 ) rivers, lakes, ftagnant waters, marfhes, and are very much expofed to the fouth and weft winds*. Dr. Ilaller's account of the fubalpine vallies of Switzerland would lead one, independently on any other fads, to fuppofe, that the goitre is partly, at leaft, owing to the influence of marfh exhala- tions. Thefe vallies, where they are level, are, according to the immortal Swifs philofopher, for the moft part marfhy. The foil is a bluifh clay. The fprings falling from the heights, stagnate Upon this clay, and give nourimment to thofe plants, which are perpetually bedewed with water. Lie thinks it is evident, from the large and rounded ftones, which are every where found, in digging cellars and wells, that thofe vallies have, in former times, been deluged by torrents of water. He fup- pofes, from the trees which are found buried in the marfhy ground, that thefe marfhy meadows, or valley-flats, were once woodlands f. * Effai, &C f " Valles fubalpinaj, frequenter, qua planre func, argillam fubcteruleam pro terra habent, qua caufa eft, ut fere paludefcant. Aquarum enim ab acclivibus delabentium fcaturigines huic argillae innatantes ftagnant, &- cjusmodi ftirpes alunt, quas aqua perpetuo amant irrigari. Super earn argillam torrcntes aut lapidum ftratum, glareafque efTundunt, aut tenues arenas, has rarius. Multiplices autem, antiquiffimis temporibus, fuiffc torrentum eluviones, magna & rotunda faxa demonflrant, qua in effoffis cellis puteifque paffim reperiuntur. Paludofa prata olim fyiveftria fuiffe, ■ex arboribus credas, qua; in terra paluftri paffim reperiuntur. Super lacus ubique, ut puto, aliquot leucarum planities eft, per quam parens ejus la- ( 6* ) From this account of the fubalpine vallies of Switzerland, there fecms to be a clofe affinity be- tween the foil and ftate of thofe vallies and the foil and ftate of many of thofe parts of North-America in which the goitre is moft frequent. In America, this difeafe, as far as I am able to judge from the fads now in my poffeffion, principally occurs in three different fituations, viz. first, in the flat or inter- vale grounds, along the margins of rivers and lakes; fecondly, in vallies; and, laftly, in the higher country, or country of wet plains, called natural meadows. On each of thefe three heads, I fhall offer a few obfervations. First. The flats along the Mohock-river, the table-lands about Detroit, and thofe between St. John's and Montreal, and in fhort all the flat land adjacent to our lakes and rivers, are inftances of the nrft kind of country in which the goitre is found. Thefe flats are generally feveral feet higher than the adjacent waters, and, in ordinary times, are not fubjed to be overflown. They are, however, ge- nerally damp, and at times, after heavy rains, the water is liable to flagnate upon them. There are feveral reafons for believing, that thefe flats were once parts of the beds of the neighbouring lakes and rivers. It is not neceffary, in this place, to men- cus fluvius, media per paluftria plana decurrit." Alberti v. Haller Hifto- ria Stirpium Indigenarum Hclveti* Inchoau. Prxfatio, p. v. ( «3 ) tion thefe reafons. It is fufficient for my prefent purpofe to obferve, that the table-lands, of which I am fpeaking, are generally unhealthy fituations. The difeafes which they moft commonly produce are intermittents, remittents, and dyfenteries. Mumps (cynanche parotidssa), croup or hives (cy- nanche trachcalis), and putrid fore-throat (cynan- che maligna) are not unfrequent complaints on thefe flats. Secondly. The goitre prevails in the vallies of our countries. We have feen that it is common in the Onondago-Valley, and in the vallies of Ver- mont. I fhall afterwards obferve, that it is a very common complaint in fome of the vallies of Mexi- co and South-America*. I believe the valley-fitu- ation, when the foil is very rich, and the air warm and moift, and efpecially if the grounds be marfhy, is, in general, peculiarly unhealthy. It is certain, at leaft, that fome of the moft unhealthy parts of America, are fome of the wet or marfhy vallies. The prevailing difeafes are malignant fevers, and dyfenteries. Thirdly. The goitre prevails in the higher country, or country of plains, where, however, the ground is generally wet, and often marfhy. * See, in the Appendix, the note to page j. ( 64 ) Such high plains arc not uncommon about the head-waters of many of our rivers, efpccially in the weftcrn parts of the United-States. Intermittent fe- vers are the moft common difeafes of thefe fituations. Tin: preceding obfervatlons are too imperfect to be of much confequence in elucidating the caufe of the goitre. They may, however, ferve to fhow, in oppofition to Mr. De Sauflurc's opinion, that this , difeafe does often prevail in the fame fituatlons in which intermittents, remittents, and dyfenteries are common. This circumftance, I am aware, does by no means prove, that the goitre is occafiV oned by the fame caufes which induce thofe com- plaints : for difeafes of a very oppofite kind, whe- ther we regard their original or their fymptoms, arc frequently found to prevail in the fame fitua- tions. The very general prevalence, however, of goitre in places that are expofed to the influence of ruarfh exhalations, would, perhaps, by moft dif- pafionate inquirers, be deemed a circumftance in favour of the theory which I am endeavouring to render plaufible. It is a circumftance, which I fhall ftill further employ in the following inquiry, where I muft, once more, regret thefewnefsof my materials. Do intermittents and remittents prevail in thofe parts of the countries of North-America, in which ( 65 ) the goitre is moft commonly met with ? I have al* ready faid that they do*. Many fads, however, muft be colleded before this question can be an- fwered as extenfively as it ought to be. Mean- while, I fhall mention fome of thofe diftrids in which both thefe fevers and the difeafe of which I am treating are very common, I have already obferved, that the Onondago- Valley, where goitres are frequent, is unwhole* fomef. Intermittents and remittents, and thefe fometimes of a very malignant kind, are frequent here. Thefe complaints are frequent in Manlius, Pompey, and other parts of the Military Trad. They are frequent along the Mohock and Con- nedicut rivers ; between St. John's and Montreal; about Detroit; on the Mufkingum, and in almofl all thofe parts of our country, in which the goitre is found. It has, indeed, been faid that intermit- tents are unknown at Pittlburgh. This is not ftridly true. On the contrary, thefe complaints are known to exift in that place, and have evidently increafed within a few years, In the prefent (late of our information; it will be difficult to prove that the goitre does adually * See pages 58, 6a and 64. f See page 51. ( 66 ) owe its origin to the fame caufes which induce inter- mittent fevers. We are certainly not yet prepared to decide upon this fubjed (as phllofophers fhould de- cide upon every fubjed which they undertake to in- vestigate), with caution. I may add, that many difficulties oppofe themfelves to the conjedure which I have thrown out. In particular, it is not eafy to conceive how a general caufe, stimulating the fyf- tem, and inducing the cold and hot ftages and other phsenomena of fevers, mould concentrate its adion fo completely upon the thyroid and neigh- bouring glands of the head and neck, and give rife to the difeafe of goitre. Perhaps, however, an extenfive view of fads relative to the produdion of difeafes by the miafmata of marfhes, would ferve to fhow the immenfe variety of ways in which thefe miafmata affed us, and the multifarious difeafes which they induce in man and other animals. There is fomething very capricious in the operation of thefe agents. And I do not know that it is more in- conceivable, that the effluvia of which I am fpeaking fliould efpecially affed the thyroid gland and induce goitre, than that they fhould efpecially affed the pa- rotid glands, producing mumps j or the liver, pro- ducing hepatitis. It may, perhaps, give fome additional weight to the theory which I have propofed, to obferve, that the marfh miafmata of fome parts of our country ( 67 ) exert a particular adion upon the glands of the neck and throat. Kalm has given fome account of a difeafe, called by the Swedes, the " flitches and burning," which, at different times, has committed great havoc at Penn's Neck, in Jerfey. " It was (fays our au- thor) a true pleurify, but it had a peculiarity with" it, for it commonly began with a great fwelling un- der the throat and in the neck, and with a difficulty of swallowing*." The complexion of many goitrous perfons, efpe- cially thofe in whom the difeafe has arifen to a con- fiderable height, is an additional circumftance in favour of the opinion which I have advanced. " Their complexion (fays De Sauffure, fpeaking of the cretins) is a yellow approaching to brown, from which probably they obtained the name of Maronsf, which is given to them in the valley of AofteJ." I was informed that in the ftate of New-York, thofe perfons who are affeded with goitre are com- monly exempt from intermittents, though in the midfl of perfons labouring under thefe latter • Travels into North-America, &c. Vol. I. p. 376, 377. &c- War" ringion: 1770. Englifh tranflation. f The maron is a large kind of chefnuf. \ Voyages, &«. Tome ii. p. 4&J- C 68 ) complaints. If this be a fad, it would rather ferve to fhow, that the goitre and the intermittent are owing to the fame caufe. I am far from imagining that the preceding fads completely eftablifh the origin of goitre from the miafmata of marfhes. I have offered this opinion merely as a conjedure or hypothesis. I cannot, however, help fufpeding that future and more ex- tenfive inquiries will eftablifh the fad, that there is a very intimate connedion between the difeafe in queftion and the exhalations from marfhy grounds. Perfuaded I am, that there is a neceffary connedion between the difeafe and a moift atmofphere*. Mr. Fodere is of opinion, that a warm and moift atmofphere is the caufe of the goitre. This writer, whom I have fo often quoted, made his ob- fervations in Maurienne, where the difeafe is ex- tremely common, perhaps more fo than in any other part of the world. It is remarkable, that the goitre prevails to the greatest degree in the western parts of North-America, where many ob- fervations have confpired to fhow, that there is a greater quantity of moifture in the atmofphere than * I do not how fpeak of infolated or detached cafes of the complaint, fcr they occur every where; but of the difeafe where it a common com- plaint. Even thofe aerial tumours which arife in women after parturition, feem only to arife in thofe fituation*, where the complaint from maifh taiaimata, or from moifture, is cndcmial. See page 4*. ( «$ ) in the countries between the Atlantic and the Alleg* heny mountains. " From a variety of obferva- tions (fays Mr. Andrew Ellicott) I am convinced that the atmofphere in the western country, and particularly in the vicinity of the lakes, contains a greater quantity of moifture than in the middle At- lantic ftates. The wooden works which contained my instruments Were always uncommonly fwelled, and frequently very much injured in that country, though conftantly defended from the rain, and oc- casionally expofed to the fun. The ivory and wood of my fedors with brafs joints, always expanded above the metal; this expanfion was not hidden, but effeded by flow degrees*." My own obfervations, which will be detailed at length in another work,f coincide with thofe of the ingenious gentleman juft quoted. The greater degree of moifture in the neighbourhood of the lakes is, perhaps, the beft explanation of the fad whkh I have already mentioned, that in general the goitre " prevails to the greatest degree in the neighbourhood of the lakes of the country, or about the firft fources of the rivers which arife near thefe lakes}." ••Tranfadions of the American Philofophical Society. Vol IV. No. XXV. page* 22J and 226. Philadelphia: 1799. f Travels through part of P;:mfylvan», Virginia, New-York, &c. &c. t See page 57. C 70 ) Mr. Ellicott has likewifeobferved, that" fogi are very common, and of remarkable denfity," on the Ohio, and Allegheny, and their branches. This accords with my own observations. I cannot, how- ever, agree with Mr. Ellicott, that thefe fogs do not contain " any portion of thofe noxious miafmata, which are fo frequently combined with the fogs on the eaftern fide of the mountains." On the con- trary, I am perfuaded, that the fogs of the western as well as of the Atlantic country are often very infalubrious. I know, at leaft, that many parts of the country along the Ohio, and other weftern wa- ters, are very unhealthy. I do not doubt that the denfe fogs are one great caufe of this unhealthinefs; and I believe, that fuch fogs are infalubrious chiefly by reafon of the miafmata which they contain. This is not the place to examine the contrary opinion, which has been adopted by Mr. Ramel. — < < < <4>>•» ► ■►—— SECTION IV. — < •«$>►■•►— Of the Cure and Prevention of thjt Disease. —■■«♦»•— I DO not think it proper to conclude this memoir without faying a few words concerning the cure and prevention of the difeafe which i ( 7* ) have been considering. This part of my fubjed, however, fhall not detain me long. I have nothing new to fay; and I am not labouring to make an ■extenfive compilation. If, as has often been afferted, the cure oi a difeafe can only be completely understood, when the caufes of- fuch -difeafe have been investi- gated with accuracy, it would follow, as a neceffa- ry conclusion, that we are not yet prepared to decide upon the belt mode of treating the difeafe in quef. tion: for I think I have fhown, that very urgent objections may be brought against every hypothesis refpeding the caufe of the goitre. But the rational empiric will fay, that-it is often an eafy talk to point out the method of curing a difeafe, even when the caufe is hidden from the refearches of "fcience. And this is a position which I fhall not deny. The remedies which have been recommended and ufed for the cure of goitre are numerous. They may be divided into two claffes, fuch as are more general, and fuch as are wholly or chiefly topical. It is not my intention to mention even the names of all thefe remedies. I fhalLfpeak of fome of -the principal of them, and that without much regard to method. I fhall fay nothing of the chirurgical management of the difeafe. ( 72 ) Among the general remedies, I may mention blood-letting and purging. Sauvages tells us, that Pafta began the cure of the bronchocele Botium by bleeding and purging, after which he had recourfe to thefal prunellas, fea-water, foap, and feveral other means, fome of which will afterwards be menti- oned*. It is, I think, highly probable, that bleed- ing has been found very ufeful in the early or forming ftage of goitre. But candour compels me to acknowledge, that this opinion is more the refult of my theoretical notions concerning the caufe of the difeafe, than of any particular or detailed in- formation refpeding the fuccefs of the pradice. Mercury, which has been ufed with advantage in fo many difeafes to which we are fubjed, has been tried in the difeafe of goitre. But it is proba- ble that it has not had a fair trial. It is certain, at leaft, that it has fometimei been ufed whilft the caufe or caufes which induced the difeafe continued to operate. Mr. Saunders, whom I have already mention- ed, informs us, that" a mercurial courfe feemedtq check" the progrefs of goitre, " but did not prevent its advance after intermitting the ufe of mercuryf." • Nofologia Methodic*, &c. Tomus Primus, p. 157 and 158. f Phllofophical Tranfa&ions, for the year 1789. Part Fjrft, ( 73 ) Dr. Stevenson informs me, that he has heard of one gentleman who was " effedually" cured of the difeafe by mercury f. Without having had any experience in the treatment of this difeafe, I muft confefs that I fhould exped not a little from the powers of mer- cury in many cafes of it. It muft not, however, be concealed, that fome writers have mentioned mer- cury as one of the medicines that are rather calcu- lated to do harm than good in goitre. Many other remedies have been recommended for the cure of goitre. Among thefe, perhaps, ) none has been more celebrated than the calcined fponge. Mr. Fodere has always given it half burnt, made into an eleduary with cinnamon and honey; and he allures us, that he has constantly found it fuccefsful. Of this eleduary, the patient takes the fize of a nut three times a-day, until the tumour difappears, which is faid to be generally the cafe within fourteen days. This author has alfo ufed foap fuccefsfully. When thefe remedies have failed to do good, he has had recourfe to the fulphure of pot-afh (liver of fulphur), diffolved in water. The daily dofe is thirty grains, diffolved in a bottle of water, and continued until the cure is effeded, | Letter to me, already referred to. K ( 74 ) Mr. Fodere fays it is advifable, during the ufe of any remedy, to take at the beginning, and every fourteen days afterwards, a laxative. The patient muft not fwallow the medicine immediately, but hold it for fome time in his mouth, fince experience has convinced him, that the remedy thus employed operates more ftrongly and more quickly. Laftly, he fays it is important to keep the tumour always covered and warm. This author thinks, the medi- cine has more effed when it is given during the wane of the moon :—an obfervation which will not, perhaps, increafe our confidence in the efficacy of any of the means recommended by him, efpecially in America, where the influence of the moon in af- lifting the operation of medicines, or in varying the features of difeafes, is lefs acknowledged than in many other countries. In fome cafes, frequent rubbing with dry well- fmoked cloths, or faponaceous remedies, or cam- phor-falve, is faid to be of great advantage*. " I have direded (fays Dr. Darwin) in the early ftate of this difeafe, a mixture of common fait and water to be held in the mouth, parti- cularly under the tongue, for a few minutes, • Eff..i, kc ( IS ) four or fix times a day for many weeks, which has fometimes fucceeded, the fait and water is then fpk out again, or in part fwallowed*." Pasta has recommended a wine-glafs full of fea-water to be taken every morning for a month and a half, and the tumour to be bathed with the fame water. When more powerful remedies are re- quired, he prefcribes three fcruples of foap diffolved in four ounces of water, or a bolus of foap, drink- ing afterwards a decpdion of the faponaria, or foap- wort (Saponaria officinalis). Lastly, this author ad- vifes the frequent ufe of the vinegar of fquill (ace- tum fcilliticum) to be continued for a month, in the dofe of two table-fpoonfuls. He likewife re- commends this vinegar to be applied externally to the tumour.f Other external applications to the tumour have been recommended. Such are a fponge wet- ted with tepid urine and an eighth part of fal pru- nellas {; ether, and fomentations of acetated ammo- niac §. * Zoonomia. Vol. II. p. 115. London: 1796. f See Sauvages, Nofologia Methodica. Tomus Primus, pages 157 and 158, \ Pafta. Sec Sauvages. $ Darwin's Zoonomia. Vol. II. p. J15. ( 7« ) We bave feen that the goitre prevails among the Indians of our country. It may, perhaps, be fup- pofed, that they are in poffeffion of fome remedies for the difeafe. But to me this does not feem at all probable. For although I am willing to allow, that the Indians are in poffeffion of many adive and va- luable medicines, ftill I am perfuaded, that their fkill in applying them is not great. The following fad, which was communicated to me by an Indian, is not altogether unworthy of being mentioned. It will, at once, fhow the miferable ftate of materia medica among thefe people, and how ludicroufly inert are the means which they employ for the re- moval of the difeafe which I am considering. According to my informant, the following is the belt method of curing this difeafe. The tumour muft be bathed with the fpittle of a virgin, and by the virgin herfelf, dum fit in menftruis. I was af- fured, that the difeafed perfon makes no other ufe of the virgin. In fome parts of our country, the Indians ap- ply the powder of burnt mufcle-fhells to the tumour, " but to no effed*". It is moft probable that they have learned the ufe of this application from fome of the whites. • Mr. Heckewelder's letter to me, dated Bethlehem, December ad, 1797. ( 77 ) I shall conclude thefe few'and very imperfed notices concerning the cure of the goitre by obferving, that I have heard of one cafe of the com- plaint in which it was thought that a watery infufion or fteeping of the bark of the root of the " Key- Afh,*" was ufed with fome advantage. The patient was a married woman, pretty well advanced in life. She drank a good deal of the infufion, and conti- nued the ufe of it for fome time. It was very dis- agreeable to take, and induced fweat. • The Key-afh is the female of one of our native fpecies of Fraxinus, moft probably the Black-afh (Fraxinus nigra of Marfhall, and Fraxi- nus fambucifolia of Willdenow). This tree is a native of various parts of the United-States. Of its medical properties, I know nothing from my own experience. I may obferve, however, that in fome parts of North-America, the bark and keys of the different kinds of am are ufed as diuretic medicines. In Pennfylvania, the bark of Marfhall's Fraxinus alba (which appears to be a variety of Linne '$ Fraxinus Americana) is ufed in intermittents, and is thought not inferior to the Peruvian bark, **0 APPENDIX, CONTAINING ILLUSTRATIONS and ADDITIONS. I AGE 5. South-America. The goitre has been known for feveral centuries in South-America. The ear- lieft notice that I have been able to find concerning it is in the Royal Commentaries of Peru, by GarcillafTo de la Vega. This writer informs us, that the Inca Tupac, af- ter having fubdued the province of Canamarquilla, " proceeded to another people called Papamarca, from the Papas or Dewlaps, which are great bunches that hang from their throats*." It will not be doubted that thefe " great bunches" were goitrous tumours. The Papamar- ca are faid to have been very numerous. Tupac Ynca Yupanqui was the eleventh king of Peru. Mr. De Pauw fpeaks of the goitre as a difeafe of the Indians inha- biting the foot of the Cordilieres. He afcribes it to the ufe of fnow-water, and fays it is called in the language of the country, Coto. He quotes, as his authority, the voyage of Sieur Acarette to Peruf. The Abbe Clavigero feems to fpeak of the goitre as a difeafe unknown in • Royal Commentaries, &c. Tranflated by Sir Paul Rycaut. Page 305. London: 1688. f Recherches Philofophiques fur le« Americains, &c. Tome Premier, p. 128. A Berlin: 1777. r 7'9 ) America*. I have not only fhewfi that it exifts, but that it is a very common complaint, in many parts of North- America. I fhall now fhow that it has long been known in that part of America in which Clavigero refided, for ma- ny years. Thomas Gage takes notice of the difeafe as fre- quently occurring at Sacapula, in Totonicapan. He firft ob- ferved it in the Prior of this place, " who, fays Gage, looked moft fearfully with a bladder from his throat fwel- led almoft round his neck, which hung over his moulders and breaft, and ftay'd Up his chin, and lifted up his head fo, that he could fcarce look any whither but up to hea- ven. In our difcourfe he told me that difeafe had been upon him at leaft ten years, and that the water of that river (the river which runs through the valley) had caufed it in him, and in many others of that town.——When I came to the town I difcovered many men and women with bladders in their throats, like the poor Prior, which made me almoft unwilling to drink there any chocolatte made with that water, or eat any thing drefled with it, until the Prior did much encourage me, and told me that it did not hurt all, but only fome, and thofe who did drink it cold.-----The air is hot, by reafon the town ftandeth low, and compafTed with high hills on every fidef." As the veracity of Gage has, by fome writers, beea called in queftion, it may, perhaps, be deemed necefla- ry to adduce fome other authority for the exiitence of the goitre in this part of America. I have lately been inform- ed, by a very intelligent Spaniih gentleman, that this dif- • The Hiftory of Mexico. Vol. II. p 34°- London: 1787. f A New Survey of the Weft-Indies, p. 25S and 236. London: 1699. C 80 ) cafe is very common in different parts of North-Ame- rica, as in Nueva Galicia, Guatemala, Nicaragua, Santa Fe, &c. It prevails to the higheft degree in Guatemala and at Santa Fe. In the firft of thefe places, it is called Guegi'ucbos, and in Santa Fe, Cotss. It affects men, women, and children, but is never accompanied with cretinifm. Mr. Miitis, the celebrated botanift, has publifhed a memoir upon the difeafe, which, it is faid, is evidently much more common now than it was eighty years fince. I exceedingly regret, that I have n,ot had an opportunity of feeing this memoir. It is a folly to attempt to prove that the climate of America is peculiarly healthy. Candour is too rare a vir- tue among philofophers ; and the defire to eftablifh fyf- tems has deluged the world with errors, and with fables. A lift of the indigenous difeafes of America (notwith- standing what the Abbe Clavigero has faid) would not be found much, if at all, lefs extenfive than the lift of thefe infirmities in other parts of the world. Page 8. Fort-Dayton. This place is fituated upon a large flat, or piece of low ground, on the Mohock-river, about fixteen miles from Old-Fort-Schuyler. The whole of the flat is occafionally liable to be overflown by the wa- ters of the river. Around the flat there is a tra£t of pret- ty high ground. Henderfon-town. This place, the proper name of v.'hich is Anders-town, is about twelve miles to the fouth- eaft of the German-Flats. The lands in the neighbour- hood are high and dry, but there are no mountains. ( 8i ) « Swelled neck." In fome parts pf New-York, this complaint is called the " thick neck." Either in this ftate, or in Pennfylvania (perhaps in both) it is called the " big throat." This nomenclature is fuflkiently defective for common ufe, and is likely to be retained in the countries in which the difeafe prevails. Page 9. Manlius. I am informed, that the goitre is moft common about the centre of this townfhip- Manlius is one of the moft eaftern ranges of military townfhips. It is watered by fome confiderable ftreams which run into the Oneida-Lake, and by fome fmall ftreams which run into the Salt-Lake of Onondago. It abounds in limeftone (See pages 25 and 26), much of which ap- peared, from my examination, to be compofed of fhells. Page 12. " The goitre of the ftate of New-York is not confined to the human kind." Sir George Staunton fays " whatever be the caufe which occafions .goitres in the human frame, it has no perceptible efted upon other animals*." This may, perhaps, be the truth, as far as refpectsthe vallies of Tartary, where he obferved the dif- eafe. But Mr. Coxe's obfervation, which I have menti- oned (See page 14), ought not to have been forgotten by Sir George •, and the fads which I have noticed (See pages 12, 13 and 14) inconteftibly fhow, that in the ftate of New-York, other animals, befide man, are affeaed with goitrous tumours. Hitherto, I have.not learned, that our animals are fubjea to fuch tumours-in any other part of ■• An Authentic Account of an embaffy from.the king of Great Britain to the emperor of China, &c. &c. Vol. II. chapter iii. p. 63. Phikkl- phia edition. T ( 8* ) North-America. This fubjea is well worthy of an at- tentive inveftigation. Page 18. " The goitre is not uncommon in the county of Bennington, and ftate of Vermont." The difeafe is likewifc known in the county of Chittenden, in the north- welt part of the fame ftate. I am not, however, autho- rized to fay that it is a frequent cafe in Chittenden. The cafes which were mentioned to me occur at Jericho, on Onion-river, which runs into Lake-Champlain. The fitu- ation a valley, ©r as it is frequently called in the United- States, a " hollow." Chittenden, on die weft, borders upon Lakc-Champlain. " Cohofs-country, in Conncaicut." This is a miftake. The Cohofs is not, as Mr. Geddis fays, in Conneaicut, but on the Conncaicut-river, in the ftates of Vermont and New-Hampfhire. The following is Mr. Morfe's ac- count of this country. " Coos, or Cobos, the country cal- led Upper and Lower Coos, lies on Conneaicut-river, be- tween 20 and 40 miles above Dartmouth college. Upper Coos is the country fouth of Upper Amonoofuck-river, ou John and Ifrael rivers. Lower Coos lies below the town of Haverhill, fouth of the Lower Amonoofuck. The diftance from Upper Coos, to the tide in Kennebeck- river, was meafured in 1793, anfl was found to be but 90 miles*." The true Cohos is, I am informed, a flat, liable to be overflown by the fpring-floods of the Conneaicut- river. ' The American Gazetteer, &c. article Co«s or Cohos. Bofto»: »797- ( *i ) " Cafee of goitre are met with among the inhabitants on the waters of the Allegheny and French-Creek, and at Sanduiky." The lands near French-Creek, where the difeafe is frequent, are level, as are likewife thofe near Sandufky. " A few inftances on Monongahela." Mr. Brackenridge informs me, that there are fome cafes of the complaint at Brownfville, or Redftone Old-fort, a town on the fouth- eaftern bank of the Monongahela, about thirty-feven miles ' nearly foutherly from Pittlburgh. Some of the worft cafes in the weftern parts of Pennfylvania occur at Brownfville. Mr. Albert Gallatin, member of Congrefs, has informed me, by letter, of feveral cafes in this part of the country. " All thefe cafes occurred in the country between the moft wefterly ridge of mountains (called from Youghiogheny- river, northwardly, Chefnut-Ridge, and wluch, from that river, foutherly, to its termination on Cheat-River, in Vir- ginia, about eight miles fouth of the fouthern Pennfylva- nia boundary, aJumes the name of Laurel-Hill) and the Monongahela-River, not more than fifteen miles weftward of the faid mountain ; but how much farther weftward it may have occurred he does not know." Moft of the cafes, Mr. Gallatin informs me, " were flight, the fwelling not greater than he has frequently feen at Geneva, in Switzer- land." Some of the cafes, however, were more ferious, particularly one or two at Morgantown (in Virginia), which is fituated upon the eaft fide of the Monongahela, about feven miles from the entrance of Cheat-River into that river. Morgantown is fituated upon open and elevated land, " not bottom-land, but of gentle afcent and level." One of the patients (a married lady) having ( 84 ) applied a mercurial necklace to the tumour, caught cold, and died in a few days, about four years ago. I knew this lady ini 785, at which time fhe refidcd upon one of the weftern branches of the Monongahela, called Muddy- Creek. She had, then, nothing of the complaint. The face of the country in which the cafes mentioned by Mr. Gallatin occurred, is " very hilly," but lefs fo than that of many of the other weftern parts of Pennfylvania and Virginia. The waterufu.illydrank, fpring*, at Mor- gantown, well-water: in neither cafe (Mr. Gallatin be- lieves) lime-ftone-water. <: In every cafe I know, fays this gentleman, the fituation is open, no trees left (land- ing, and large plantations cleared around." He particu- larly mentions two cafes occurring on a farm, about four miles north-eaft of Brownfville, the fame diftance from the Monongahela, ten miles from the Laurel-IIill, and half a mile from Dunlap's creek. " Situation of the houfe al- moft at the bottom of a hill, not very fteep nor high, as it is cultivated to the very top ; and on the verge of a valley containing about one hundred acres of meadow in front of the houfe. This meadow is crofled by a run, and part of it is liable to occafional overflowing. The land of the greater part of the plantation is firft rate, and about two hundred and fifty acres are cleared*." Mr. Brackenridge informs me, that there are a few cafes of goitre at Cannonfburgh, a fmall town fituated on the north-fide of the weft branch of Charticr's creek, about feventeen miles fouth-weft of Pittlburgh. Chartier's is a * Letter to me, dated April 8th, 1800. ( «5 ) branch of the Ohio, into which it empties itfelf about five miles below Pittfburgh. Page 19. " It does not appear from Dr. Stevenfon's letter, that the difeafe has, in any inftances, arifen to a very troublefome or alarming height." I am, however, inform- ed, that in two cafes (both females) in Pittfburgh, the tu- mour has grown " to an enormous fize." A young wo- man at Brownfville was, for years, affeaed with this tu- mour " almoft to fufFocation." It was confiderably larger than her breafts. The complaint was " removed" by a Dr. M. Page 28. " There is no lime-ftone in the county of Bennington." I have fince been informed, that both lime- ftone and marble are very abundant in this county. Page 35. Townfliip of Pompey. This townfhip is adjacent to Mualius, by which it is bounded on the north. It is watered by the fame principal ftreams which water Manlius. The Onondago-Creek, which is the weftern boundary of both the townfhips, runs northerly into the Salt-Lake of Onondago. Page 37. Tophus Ludus. This is the Porus of fome of the old authors. The Tophus Polymorphus of Wal- lerius. Syft. Vol. II. p. 394. The Tophi of Kirwan, p. 25. It is called Duckftein by the Germans. Is formed by the gradual depofition of earths, efpecially the calca- reous earth, which are diffufed in water. Of a foft and porous texture (hence the old name Porus). Thefe incruf- tations are very abundant in many parts of North-Ame- ( «6 ) net, but perhaps no where more abundant than in the fame parts of the Military Traa, where (he goitre is a common difeafe. See pages 25 and 26. Pages 42 and 43. "As we approach the northern parti of our continent we find a great many of the plants of northern Europe. This faa," &c. It has long been known, that the northern parts of America poflefs a great many of the vegetables of the north of Europe and Afia. Kalm fays near half of the plants which are met with at Lorette, in Canada, grow in the woods and moraffes of Sweden.* He tells us, that the forb-trce, or mountain-afh, the cran- bcrry-bufh, the juniper-tree, the fea-fide peafe, the Lin- nxa, and many other Swcdifh plants, are likewife to be met with at Bay St. Paulf. I am perfuaded, that fome of the plants mentioned by the Swcdifh traveller are not fpccifically the fame in Europe arid in America. But I am equally perfuaded, that (exclufively of the moffes and' other cryptogamick plants) there is a confiderable number of plants that arc common to thofe continents. A lift of thefe, together with their comparative magnitude, extent of range through the country, &c. will be particularly attended to in the Introduaion to my Flora of Pennfylva- nia and the adjacent ftates. Page 46. " I have taken notice, fays he, when it firft made its appearance in girls, which was never until they were employed in carrying burdens." This obfervation of Mr. Heckewelder is a curious one, and deferving of at- 1 Travel*, &c. Vol. III. p. 16c. f The fame, p. 21; (87 ) tention. Perhaps, however, it only ftiows that the goitre has often a peculiar tendency to appear about the age of puberty. Mr. Saunders, fpeaking of this difeafe, fays, " It generally appears in Boutan at the age of thirteen or fourteen, and in Bengal at the age of eleven or twelve; fo that in both countries the difeafe fhows itfelf about the age of puberty.*" Several of the cafes of which I have received information firft occurred about the age of pu- berty. Mr. I. O. at the age of fourteen, firft " became fen- fible of the fwelled throat," at Cannonfburgh, already mentioned. I cannot, however, from the few faas now in my pofiefiion, pretend to affert, that the goitre is par- ticularly difpofed to appear about this time of life. It muft be remembered, that many of the perfons affeaed with this difeafe, had not an opportunity of contraaing the complaint until they had palled the era which I have men- tioned. Moreover, it is certain, that many perfons who have been born and bred in the diftrias where it pevails, have been feized with the fwelling long before the age of puberty. See page 19. I am informed that at Detroit it commonly makes it appearance in children about the age of three years. Mr. Fodere fays, it generally appears, in Maurienne, about the fevertfh or eighth year. However, he faw one cafe in which the tumour arofe as early as the fourth day.f Page 49. Cretinifm. I have heard of fome cafes of cre- tinifm among the Indians inhabiting the neighbourhood of Sandufky. But fuch cafes are undoubtedly very rare in * Philofophical Tranfaa.ions, for the year 1789.. Part Firft. f Eftai, &c, ( 88 ) North-America. This circumftance, as 1 have remarked, is " well calculated to fhow that the goitre and idiotifm are not neceffarily conncacd with each other." If, however, cre- tinifm be cvct the consequence of goitre (and of this, I think, there can be little doubt), there is much reafon to fear, that at fome future period, cretins will not be uncommon in fome of thofe vallies and other lituations of America where goitre is now a frequent complaint. Time only may be wanting to produce the dreadful calamity, which depriving man of his phyfical and intelleaual ftrength, and, by confe- quence, unfitting him for the various duties of life, re- duces him to the condition of the brute. A faft menti- oned by Mr. Fodere will fhow that my fufpicion is not entirely without a foundation. This writer, after re- marking that the goitre is either hereditary or cafual, fays, if but one of the parents has a cafual goitre, it will not be inherited by the children: but .f two per- fons affliaed with the difeafe, intermarry; if this be conti- nued through feveral generations, and if they remain in a neighbourhood where ^ f The Hiftory of Sumatra, &c. p. ai. X 93 ) I had not an opportunity of confulting Mr. Marfden's work, until after the firft eighty pages of this memoir were printed off. I confider the faas which he mentions as being very favourable to the theory of the caufe of goitre which I have advanced. I may add, that at Pittf- burgh, where the difeafe is common, there is every morn- ing, in the fummer and autumnal months, an extremely denfe fog, which is not difperfed until a good while after fun-rife. The people of this town, even thofe who fpeak in the higheft terms of the healthinefs of the place, do not attempt to deny, that the fog is remarkable, and very difagreeable to the feeling.----■—Upon the whole, the farther I proceed in this inquiry, the more I am in- clined to- believe, that the principal remote caufe of goi- tre « is a miafm of the fame fpecies as that which pro- duces intermittent and remittent fevers, dyfenteries, and fimilar complaints." I pretend not to determine, what is the precife nature of that miafm. This and many other points which I have touched upon, in the preceding pages, I fubmit, for the prefent at leaft, to the judgment of thofe who have leifure, and more inclination than myfelf, to woo the « fairy favours!" of conjeaural fcience. f Dryden. ____ THE END. PHILADELPHIA, May 26th, 1800, ( 94 ) ERRATA, Ac. In the Priiaci, page vi, for fet, read fit. Page -Q,f»r °"e country, r.-aJ our country. 4", for bronchia, rtad trachea. 50, f»r reflected back, read reflected. $2, for Alkghaney, read Allegheny. 70, title, for Of TUF. CURt AND PREVENTION Of Tilt DISFASC, ruJ or the cure or the disease. In the fame page* laft line, for the cure and prevention of the difeafe, rtad the cure of the difeafe. j>3 and 44, in the margin, trafe the wards, See Appendix. Book taken apart, leaves deaoidlfled with magnesium bicarbonate* Folds relnforoed, resewed on linen oords, new all-rag end paper signatures, unbleached linen hinges, hand sewed headbands* Rebound In quarter Russell's oasis moroooe, hand marbled paper sides, vellum corners. Leather treated with potassium laotate ft neat's foot oil ft lanolin. September 1975 Carolyn Horton ft Assoo. ("OHO Hi^-r 1+30 West 22 Street \y £ New York, N.Y. 10011 J_ 70 * / .3 rrx ____— aoxaflK BINDBRY ' "CO C\ \