GOITRE IN MULTAN DISTRICT.

By J. R. CHAUDHRI, m.r.c.s., i-.r.c^, d.p.h. (Camb.). District Medical Officer, Mult an.

In the course of medical inspection of school children of Mulepur, a village in Kabirwala talisilit was noticed that a re-

markably larg-e number of children suffered from simple goitre. Out of a total number of 70 boys examined, 32 were found to be

suffering from goitre?a very high per- centage. Further investigation showed that

goitre exists not only amongst the students of the 1st and 5th classes that were examined medically, but also in all classes. The follow-

ing statement gives the extent of incidence of the disease in each class:?

Class. Number of boys exa-

mined.

I 57

II

III

IV

V

VI

22

13

8

16

9

Number of goitrous boys.

20

19

8

7

12

7

Percentage.

35.1 per cent.

86.4 per cent.

61.5 per cent.

87.5 per cent.

75.0 per cent.

77.8 per cent.

This state of affairs naturally led me to

look for goitre amongst the grown-up people of the village. I found a large number suffer" ing from this disease. In a small village 400 souls there arc about 15 persons with very

big necks (Derbyshire necks). These are the

persons whom everybody in the village knows by reason of their prominent necks. there exists a considerably larger number

0

persons who have goitres of too small a size to be noticed by laymen. As a matter of faC '

Sept., 1929.] GOITRE IN MULTAN DISTRICT: CHAUDHRI. 493

I believe that about 60 per cent, of the

population of this village suffers from goitre. I was told that the disease prevails much

more amongst the females than amongst the males. I could not personally verify this fact because one is unable to' see a large number of women. They told me, however, that there are more women than men who have got big goitrous necks. There are in this village 3 persons who have

subnormal brains, one of them is feeble- minded and has goitre, the other two are

cretins, and one of them definitely suffered from goitre. It is possible that there is some

correlation between goitre and cretinism.

Age Incidence:? The disease seems to attack all ages

except the infants. I examined many infants but none of them showed any appreciable enlargement of the thyroid glands.

I also visited three villages situated in the neighbourhood of Mulepur, namely Bute

Singh Wala, Jawandsingh Wa1a and Koliiwala. he following1 statement gives the incidence the disease amongst the school children in lese 3 villages.

Class

I II

III IV V VI

Number of boys examined.

8 6

12 13

47 .31 16 12 14 13

22 8 5 7

Number of goitrous boys.

13 5 5 6

It is clear from the above that goitre is endemic in these villages also. Moreover, medical examination of school children at

Sardarpur and Sarai Sidhu also revealed the existence of goitre in the villages of Aulak Sidhu. Bagar and Sardarpur. I, have also seen cases of goitre in Jaso Kanwan, another village of Kabirwala tahsil. The following statement gives the incidence of simple goitre in each village, the situation of these villages is shown in the attached map of this

district. It would appear that the disease is

highly endemic in the whole of Kabir\va!a tahsil, especially so in the villages situated along- and quite close to the Ravi river. I have

MAP OFTME

MULTAM DISTRICT

Noit:- dlack dots s/ioiv ihe places mfected

frith Goitre I ' I

MAP omre

MULTAN DISTRICT

49+ THE INDIAN MEDICAL GAZETTE. [Sept., 1929.

also seen cases of goitre in some villages of Multan tahsil. In Multan city itself the disease is widely prevalent. I also noticed

goitrous cases in Taraf Muabarak, a suburb of Multan city. Similarly, I noticed cases of

goitre in Tulamba, Khanewal tahsil.

It appears therefore that the disease is

essentially endemic in the whole of Kabirwala tahsil.

The extent of incidence in families in Kohiwala. I enquired from five different families, taking

them as random samples. T found the

following-:? 1. Of 7 members of a Hindu family 5 have

got goitre of big size. 2. Of 3 members of a Hindu family 1 has

got goitre. 3. Of 9 members of a Hindu family 3 have

gfot goitre. 4. Of 6 members of a Mohammadan family

2 have got goitre (brother and sister). 5. Of 7 members of a Mohammadan family

2 have got goitre.

Symptoms and III Effects:? The following four patients with big

goitres were examined for symptoms:? (1) Satu.?A female, aged 35, big goitre, pulse rate

80, dyspnoea on exertion, no exophthalmos, no tremor. (2) Para.?A male, aged 60, big goitre, has tremor

of the head, has dyspnoea, palpitation and giddiness, no exophthalmos, pulse rate 82.

(3) Nand Lai.?A male, aged 10, shows tendency towards exophthalmos, has big goitre but no other symptom, pulse rate 80.

(4) Chanan Das.?Pulse rate 88, has got big goitre, shows tendency towards exophthalmos.

The last two are brothers. The fact that several members of a family

escape from this, disease shows that there is

more than one factor at work in the causa-

tion of the disease, that some are more dis-

posed to this disease than others.

Pathology:? The size of the goitre varies greatly. All

varieties from slight but appreciable enlarge- ment of the thyroid gland to very big hard colloidal goitres of the size of a foetal head can be seen. Amongst the school children it

is simply a parenchymatous enlargement of the gland. In some of the grown-up people the goitre seems to be of the fibro- adenomatous type.

Tn most cases the whole of thyroid gland is involved, but T have seen cases of unilateral enlargement of the thyroid gland as well a*

cases in which the central lobe of the thyroid gland was enlarged.

It is now an established fact that goitre due to iodine deficiency in water, food and soil, and that the thyroid gland undergoes compensatory hypertrophy in order that ^

may provide the system with the necessary

quantity of iodine. Samples of water, food and soil taken from four different villages were sent for chemical analysis to detect iodine deficiency. The analyst reports that iodine is absent in the samples sent to him. Presum- ing- that the analyst employed sufficientl) delicate technique in detecting iodine in the

specimens of food, water and soil, there is thus

sufficient ground to believe that- the theory ot

iodine deficiency is correct.

The condition of sanitation and the purity of the water supply are said to play an ,IT1"

portant part in the incidence of this disease- There is no doubt that the sanitation of the

villages in which 1 have noticed cases of g"?^fe is exceedingly poor, but other villages

1,1

'

Name of Village.

Jodhpur

Raipur Chak Sher Khan

Qadirpur Ran

Bangalwala Bohar Hajipur Luthar

Class.

I II

III IV V I I

II III IV V I

II and III IV VI VII VI VI VI VI

Number of Boys Examined.

Moham- madan.

10 1 3 9

is 33 8 2 5 3

28 11 12 9 9 7

10 8 6

Hindus.

30 14 21 9 4 10 3 1 2 3

10 3 3 4 1 3 1 4 1

NumpEr of Boys suffer- ing from Goitre.

Moham- madan.

1 12 3

Hindus.

Percentage of

Goitrous Children.

Moham- madan.

30 per cent.

100 ?

33.3 ?

5.6 36.4 37.5

33.3 28.6 9.1 16.7

11.1 14.3

75.0

Hindus.

20 per cent. 21.4 28.6 33.3 50.0 30.0 66.7 100.0 50.0 33.3

20.0

33.3 25.0

66.7 100 0 50.0 100.0

Sept., 1929.] MOSQUITOES OF FRENCH INDIA: BOREL & LABERNADIE. 495

which goitre is not endemic are no whit better in the matter of sanitation. The

purity of the water supplies in these villages is likewise highly questionable even as it is in other villages of the district. I cannot, therefore, establish any definite relationship between bad sanitation with impure water supply and the incidence of goitre.

Prevention of Goitre:? As for the prevention of goitre, the following

quotation from Rosenau solves the problem of prevention admirably :?

"

The essentials of goitre prophylaxis are

low cost, palatability, ease of administration, minute dosage, harmlessness and efficiency of the iodine preparation used. The method most favoured at the present time is the use of a chocolate tablet containing 10 milli- grammes of iodine in the form of an organic acid. This form of iodine has the advantage of being tasteless, non-hygroscopic and very stable. It is so much more pleasant and practical than sodium iodide that Kimball recommends it. One or two of these tablets, according to the age and requirements, should be given each week during the school year to boys and girls, especially between the ages of eleven and sixteen."

It is proposed to try the administration of iodine both as preventive and curative

amongst the school children in Kabirwala tohsil to begin with. Later on, I have no

doubt the remedy will become very popular, as goitre is so prevalent, and we may well e*pect the people themselves to resort to this remedy. It may be interesting perhaps to note that most of the goitrous persons showed a considerable anxiety to get cured of this djsease not on account of any particular disabling symptom, but because of the serious flisfigiiremen^ the disease causes.