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Switzerland according to Ewald, 12,277 re(ruits were disqualified out of a number of 300,000 annually, or 4 per cent. (Osler). In these same communications we have the study of the region about the Great Lakes in Canada,

M. P. Kemp studied 425 women of the Newberry Asylum previous to 1917 and noted that 28 per cent. had goiters, 5.8 per cent. developed them since coming here, and for a period of six years 21 per cent. of the admissions had


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CHART NO. II. 583 Registrants examined in Division No. 2, Houghton Co., Michigan.


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According to ('. S. Willer's statist's, goiter is increasing in the United States. This is based on Hadilicka's statement from the United States National Museum.

2. DISCUSSION OF PHYSIOLOGY AND PATHOLOGY thymus, hypophysis, adrenals, ovaries

will be

a matter for the future study to decide. In spite of much work, and study on the en

The knowledge attained by the study of thydocrine glands of the body in their occurrence

roidectomized animals, this effect on metabin individuals and in communities where they are prevalent has led to conflicting hypotheses olism, (Means and Aub) and the correlated as to their function and their control of metab

symptoms and signs in the human subject be

fore and after lobectomy, or the various types olism of the body. More thorough and con

of resections add many stepping stones to ulticlusive evidence must be obtained before we

mate solving of the problem of the physiology can justify positive statements as to their real

and pathology of this gland. role in development, selection of function and

The observation in the female who presents causation of pathologic changes.

more likelihood of an enlarged or changed E. C. Kendall's isolation in 1915 of the thyroid on account of her varied physiological alpha-iodin crystals and its use in cretinism and career, shows enlarged thyroid during puberty, myxaedema is a good step in advance. The menstruation, menopause, and pregnancy, difficulty in the separation of this substance demonstrating the need for thyroid activity.

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From Tabulation of 583 Registrants examined in Division No. 2, Houghton Co., Michigan.

makes progression along this line very slow. It was said by Dr. Charles Mayo that eclampsia An interesting point in the use of the sub- resulted in pregnant women in whom there was stance in normal individuals bears

a relation

an hypothyroidism. This is an interesting to thyrotoxicosis of hyperthyroidism, but the statement if not altogether accurate. The repeculiar chronic toxicosis cannot be reproduced moval of an ovary may excite an attack of artificially in the normal individual. The body hyperthyroidism. All this demonstrates the has ameliorating substances to offset this in- need of the thyroid in development and metabtoxication produced artificially, manifesting a olism and the interdependence, of the various tolerance. Therefore, not only the excessive glands of internal secretion. secretion of the thyroid causes the symptoms, 3. STUDY AND DISCUSSION OF 583 REGISTRANTS but also the various substances that it excites Any grouping of large numbers of facts and in other organs of internal secretion, that give records will add to the sources of supply that the multiple pathology of a so-called case of eventually bear fruit of ultimate knowledge. hyperthyroidism or Grave's disease. To what Therefore, I wish to present tonight a study extent the thyroid activity may be influenced of the thyroid occurrences in 583 Registrants by other organs in a pathological state as the of Division No. 2 of Houghton County, Mich

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igan. My connection dates from Feb. 23, 1918, or hyperthyroidism is certainly one of the most and therefore I could only study those that feared conditions of disease on account of its came under my control from the date of my great danger to the vital organs—as tachycommission as examining physician to the cardia with miocardial degeneration, mental Board. I studied and tabulated the cases that and nervous irritability, and exhaustion, exappeared at the registration of June 5th, Aug. ophatholmos, weakness, loss in weight, and the 24th, and Sept. 12th, 1918, that were exam- various degenerations of the liver, kidney, and ined by the associated physicians and myself. nervous system. The example of a patient at Most of the registrants I personally saw. Their the height of an attack of the Grave's disease ages ranged from 18 to 21 and from 32 to 36 is sufficiently alarming to justify more study years inclusive.

and care on the part of the physician and surThe definition of goiter that I used was "any geon. palpable enlargement of the thyroid gland.” Even the so-called simple goiters and adeThe pathology that gives this enlargement, of nomatous goiters have the potentiality of thy

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CHART NO. IV. Total Goiters and Large and Toxic (Disqual.) Goiters estimated from the percentages found in the

583 Registrants examined in Division No. 2, Houghton Co., Michigan.

course, is the basic cause for disease of this rotoxicosis. From the large amount of matergland, and, therefore, we can classify them into ial at the Mayo clinic, Plummer drew the confour clinical groups. (Judd).

clusion that 20 per cent. of all simple goiters 1. Simple colloid. 2. Adenomatous. get a goiter heart in fourteen and one-half Toxic goiters, which are found hyperplastic. years. Allan Graham, at the Western Reserve 4. Malignant.

University, discovered that dessicated adenoThe danger to the individual depends upon mata (adult and foetal) could produce the the type of goiter, its size, and position. As same changes as normal thyroid secretions, we know large, colloid and adenomatous masses which gives to the simple goiter the potentiality press upon the adjacent organs of the neck, of toxic goiter. trachea, oesaphagus, recurrent laryngeal nerve, In my own observation I believe that the and large vessels of the neck, causing symptoms high tension produced by the war, amongst of dyspnoea, dysphagia, hoarseness ( or apho- young men and also their worrying and nervenia) and cyanosis respectively. Thyrotoxicosis strained relatives, whipped up many quiescent


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goiters, and also excited the potential simple toxic states later, and, also, more carefully goiter to activity causing many cases of acute examined heart diseases. hyperthyroidism with its accompanying symp- The deleterious effect of goiters was discovtoms. I have examined and treated several of

ered in a small number of families of Morons this type during the last year.

whose parent or parents had very marked de S. P. Beebe, in an article in the Medical

forming growths of the thyroid. Record of February, 1918, corroborates my own

It appeared in observation of my practice observation in this regard. As I have found

coupled with my tabulated cases that persons in a limited number of cases Beebe has describ

were in danger of thyroid enlargement and its ed in many camps, that many cases of so-called

associated symptoms when born in this "goiter soldier's heart and so-called "psycopathies"

belt.” Also, persons or families who had opwere true cases of hyperthyroidism.

portunity for travel and lived in other sections The large numbers of goiters strike one as

of the country for any length of time each a very important factor in the study of the

year, were less prone to thyroid difficulties. man power efficiency, and the possible ultimate

On examination of 583 registrants, I found effect on posterity. As we know the goiter

that 177 of that number or 30 per cent. showed question rises in Switzerland to a national

a demonstrable enlargement of the thyroid, problem, it is incumbent on us not to disregard

140, or 24 per cent. of the total number examthe issue when I will show you a percentage in

ined were simple goiters, 23, or 3.9 per cent. thyroid defects greater in itself than any other

were toxic goiters and 14'or 2.4 per cent. were defect. We have more goiters in males tabu

large goiters of the adenomatous, colloid or lated than all other defects added together. cystic types of a disqualifying nature. You can Quoting from a non-official communication to

readily see that these figures, by comparing the Major Peterson in August 17, 1918, I stated :

charts Nos. I, II and III, demonstrate without “Of the 1918 class of June 5th (all of which

any doubt the importance of the goiters amongst were 21 years of age) who were born in this

men of our section. district, practically one-third had an enlarged thyroid gland of some degree—some definitely

In investigating the places of birth I found

that of 155 men of 21 years of age, all but having large cystic, adenomatous, colloid or

three were born in the section of the goiter toxic goiters. Some of these boys have a definite decrease in efficiency from every stand

belt. Therefore, the presence of a goiter in point—unable to do average mental or physical

95 per cent. of cases of young men marked the labor, having decreased mentality, or suffering

place of birth. from dyspnoea or a definite toxic state with the The percentage varied with ages on account usual symptoms of hyperthyroidism."

of the incidence of goiter and also on the numMore men were disqualified for military

bers examined, but the average would be a just service according to the regulations from large

estimate of the actual percentage. and toxic goiters, than from any other defect. The decreasing percentage as the registrant For instance, on referring to chart No. 1, you grew older is due to the fact that a certain will see that amongst the 583 registrants exam- proportion of older members of the community ined we have 37 goiters (large and toxic), and may have been born elsewhere, and that they 20 hernias, 31 total deformities of the bones had traveled in non-goiterous districts. Both and joints and 16 heart diseases. (One inter- factors make up for a decreased hypertrophy esting feature shows the very low percentage and hyperplasia of the thyroid, and argues in of venereal diseases. This is due to the fact favor of the popular belief in some local inthat the young men prepared themselves for fluence from the water supply exiciting the examination by prevention and treatment, dem- growth. onstrating the value of propaganda).

I believe that 30.3 per cent. is a true proOf the total number of disqualifying defects, portion of goiters in males judging from the goiters stood 20.9 per cent. or more than one- males examined, and that, therefore, chart No. fifth, total deformities next, at 17.5 per cent., IV, gives us percentages very close to accuracy hernia, 11.3 per cent., and heart diseases 9 per to the number of goiters in the Upper Penincent.

sula of Michigan and Houghton County, MichThe percentage of toxic goiters will increase igan. Furthermore, the female, as I have said in my mind to 8 per cent. to 10 per cent. if we before, is more prone to the thyroid enlargeadded to those found the men who developed ment than the male. It is a known fact that

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Beebe, S. P.: Med. Record, Feb. 9, 1918.
Bircher: Practical Med. Series 275, Vol. II, 1918.

Editorial: Journal A. V. A., Page 1826. Nov. 30, 1918.

Graham Allan: Practical Med. Series 294, Vol. 1, 1917.
Jolinson's Surgery.

Mayo Clinics 1914-1915-1916.

Miller, C. S.: N. Y. Med. Journal, Page 1216, 1917,
Osler: Modern Medicine, Page 403, Vol. VI.
Sherrill, J. G.:

there are nearly two females to one male with ureteral stone symptoms are often due to a goiters in the section.

spondylitis. It is apparent that a routine I used the word disqualifying to mean cases examination of the spine is important in diagwith large and toxic goiters according to the nosing obscure lesions especially where pain is definition in the Selective Service Regulations. an important symptom.

The figures when developed would be still In this discussion I desire to refer briefly more startling. Therefore, in Registration to four classes of vertebral lesions, to report a Division No. 2 of our County, there are 9,615 few cases and to exhibit some slides showing goiters with 1,999 of a disqualifying character; these conditions. The four classes of vertebral in Houghton County 26,694 goiters of which disease are Pott's disease, malignancy, spondy5,550 are disqualifying types; and in the Up- litis deformans and spondylolisthesis. Tuberper Peninsula of Michigan there are 98,665. culosis of the spine is a frequent and well undergoiters with large and toxic types numbering stood condition. In children it is of such com20,515.

mon occurrence that the clinician is on the The economic and social importance of these watch for this condition and seldom overlooks figures cannot be denied.

it. In adults the condition is also frequently

present. The pathological process is an osteoBIBLIOGRAPHY.

mvelitis usually of the body of the vertebra. J. M. S. M. S., Page 463, Vol. XLII.

Bv a destructive process the bone is broken

down and the vertebra collapses causing the Dunhill, T. P.: Int. Ab. of Surgery, 321, 1918.

well known deformity. Pain is often an early Epler, B. N.: J. M. S. M. S.. Feb., 1918.

symptom. The location of the pain depends

upon the point in the cord at which the verKemp. M. P.: Practical Med. Series 275, Vol. II, 1918.

tebral disease occurs. The pain may be in the Int. Ab. of Surgery, July, 1918.

chest or abdomen. Abdominal pain may sugMeans, J. H. & Aub., J. C.: Journal A. M. A., July 7, 1917.

gest disease of the stomach, appendix or kid

ner's. J. M. S. M. S.. Aug., 1918. Smith, E. V.: Int. Ab. of Surgery, 229, Oct., 1918.

Carcinoma of the spine is not a rare disease.

It is a metastatic process. The most common VERTEBRAL DISEASE AS A CAUSE OF sites of the primary growth are the female REFERRED PAIN.*

breast and the uterus. The disease involves John B. JACKSON, M.D.

the spongy portion of the body of the vertebra.

Invasion of the canal takes place rarely. Root KALAMAZOO, MICH.

pains are of extremely frequent occurrence and In the examination of patients often the are early and troublesome symptoms. When physician is unable to explain adequately the the disease has progressed sufficiently the vercause of pain. This symptom of pain is the tebra collapses as in Pott's disease and deformone most readily recognized by the patient and ity and symptoms of cord compression occur. the one most likely to bring him to the doctor. One vertebra alone may be involved, but as a Examination of the spine will often reveal ver- rule the growth invades two or more adjacent tebral diseases as a cause of pain that cannot vertebra. Root pains following an operation be accounted for otherwise. Sensory disturb- for cancer should always suggest a secondary ances in diseases of the spine have not received invasion of the spine. the attention they deserve. Mistakes have been

Spondylitis deformans is of much more fremade in diagnosing visceral disease as a cause

quent occurrence than is commonly appreciated. of the sensory disturbance when the real cause

In this discussion no attempt will be made to has been a pathological process in the vertebrae

classify this process as to etiology or types of that has caused an irritation of the nerve roots. rigidity, but all forms of spinal arthritis with

Rogers and Foley in reporting an analyses bony changes will be grouped together. Prof. of 75 cases of tuberculosis of the spine report Elliot Smith has shown that this disease was that four cases had been considered gastro

very common among the prehistoric Nubian intestinal, one had been operated for gall-stones, people. Its extreme prevalence is shown by one for appendicitis, one for perinephritic ab- the fact that in one prehistoric cemetery exscess, one had a nephropexy. Blaine and others plored every adult body presented more or less have called attention to the fact that renal and

extensive signs of its effects. The following

brief description of the pathological changes * Read before the Kalamazoo Academy of Medicine.

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