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$19.

Goitre and Cretinism.

19. GOÎTRE AND CRETINISM.

"Quis tumidum guttur miratur in Alpibus."-Juv.

It is a remarkable fact that, amidst some of the most magnificent scenery of the globe, where Nature seems to have put forth all her powers in exciting emotions of wonder and elevation in the mind, man appears, from a mysterious visitation of disease, in his most degraded and pitiable condition. Such, however, is the fact. It is in the grandest and most beautiful valleys of the Alps that the maladies of goître and cretinism prevail.

Goître is a swelling in the front of the neck (of the thyroid gland, or the parts adjoining), which increases with the growth of the individual, until, in some cases, it attains an enormous size, and becomes "a hideous wallet of flesh," to use the words of Shakspeare, hanging pendulous down to the breast. It is not, however, attended with pain, and generally seems to be more unsightly to the spectator than inconvenient or hateful to the bearer, but there are instances in which its increase is so enormous that the individual, unable to support his burden, crawls along the ground under it.

Cretinism, which occurs in the same localities as goître, and evidently arises from the same cause, whatever it may be, is a more serious malady, inasmuch as it affects the mind. The cretin is an idiot- a melancholy spectacle—a creature who may almost be said to rank a step below a human being. There is a vacancy in his countenance; his head is disproportionately large; his limbs are stunted or crippled; he cannot articulate his words with distinctness; and there is scarcely any work which he is capable of executing. He spends his days basking in the sun, and, from its warmth, appears to derive great gratification. When a stranger appears, he becomes a clamorous and importunate beggar, assailing him with a ceaseless chattering; and the traveller is commonly glad to be rid of his hideous presence at the expense of a batz. At times the disease has such an effect on the mind that the sufferer is unable to find his way home when within a few feet of his own door.

Various theories have been resorted to, to account for this complaint some have attributed it to the use of water derived from melting snow; others, to the habit of carrying heavy weights on the head; others, again, to filthy habits; while a fourth theory derives it from the nature of the soil, or the use of spring-water impregnated with calcareous matter.

As the goître occurs in Derbyshire, Notts, Hants, &c., where no permanent snow exists and no rivers spring from glaciers - also in Sumatra, and in parts of South America, where snow is unknown, it is evident that the first cause assigned is not the true one; as for the second and third, they would equally tend to produce goître in the London porters, and in the inhabitants of the purlieus of St. Giles's. If the limestone theory be true, all other rocks should be exempt from it, which is not the case, as far as our experience goes.

Goitre and Cretinism.

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§ 19. Goître is found only in certain valleys; nor, when it does occur, does it exist throughout the valley. It appears in one spot; higher up it is unknown, and in another situation, a mile or two distant, perhaps, it is again prevalent. A curious example of this is afforded by the valley leading up to the Great St. Bernard. Goître is unknown above Liddes; abounds at Vercheres, 800 feet lower down, and almost universal at Orsieres; had the disease depended upon the glacier water, it would, of course, be more prevalent near to them and in the upper part of the valley.

A careful attention to the circumstances accompanying its appearance will show that it is connected with the condition of the atmosphere, and is found in low, warm, and moist situations, at the bottom of valleys, where a stagnation of water occurs, and where the summer exhalations and autumnal fogs arising from it are not carried off by a free circulation of air. That it is, in fact, one of the many injurious effects produced by malaria. It prevails in places where the valley is confined, and shut in, as it were where a free draft is checked by its sides being clothed with wood, or by a sudden bend occurring in its direction where, at the same time, the bottom is subject to the overflowings of a river, or to extensive artificial irrigation. The conjecture which derives the disease from breathing an atmosphere of this kind, not liable to be purified by fresh currents of air to carry off the vapours, is, perhaps, not undeserving of consideration, and further investigation on the part of the learned.

Goître is much more common in females than in males, and usually occurs about the age of puberty. It becomes hereditary in a family, but children born and educated on spots distant from home and in elevated situations are often exempt from it. At Sion, in the Vallais, which may be regarded as the head quarters of goître, children and even adults are often removed to the mountains from the low ground on the first symptoms of the malady, and the symptoms disappear where this is resorted to in time. Iodine has been applied with success as a remedy in some cases; but, as it is a dangerous remedy, the administration of it must be resorted to with the greatest caution.

ABBREVIATIONS, &c. EMPLOYED IN THE HAND-BOOK.

The points of the compass are marked by the letters N. S. E. W.

(rt.) right, (l.) left,-applied to the banks of a river. The right bank is that which lies on the right hand of a person whose back is turned towards the source, or to the quarter from which the current descends.

Miles.-Distances are, as far as possible, reduced to English miles; when miles are mentioned, they may be understood to be English.

The names of Inns precede the description of every place, (often in a parenthesis,) because the first information needed by a traveller is where to lodge.

Instead of designating a town by the vague words " large," or small," the amount of the population, according to the latest census, is almost invariably stated, as presenting a more exact scale of the importance and size of the place.

In order to avoid repetition, the Routes are preceded by a chapter of preliminary information; and, to facilitate reference to it, each division or paragraph is separately numbered.

Each Route is numbered with Arabic figures, corresponding with the figures attached to the Route on the Map, which thus serves as an Index to the Book; at the same time that it presents a tolerably exact view of the great and minor roads of Switzerland, and of the course of public convey

ances.

The Map is to be placed at the end of the Book.

The view of the Bernese Alps to face page 67.

Mont Blanc from the Brévent, 321.

The Coats of Arms on the cover are those of the 22 Cantons forming the Swiss Confederation.

SECTION I.

SWITZERLAND.