Making Endemic Goiter an American Disease, 1800-1820.

In 1800, American physician and naturalist Benjamin Smith Barton (1766-1815) published A Memoir Concerning the Disease of Goitre as it Prevails in Different Parts of North-America. The text documented the nature of the disease in the United States and highlighted how it differed from the ailment's presentation in European patients. While medical topographies were common during this period, Barton's goiter research and the steady stream of American goiter research that followed are worth special attention. This body of literature demonstrates how American physicians understood their relationship to transnational medical discussions and the unique perspective they brought to them. Goiter literature was common in European medical and travel writing during this period and intensely focused on the appearance of the disease in the mountains of Switzerland and Northern Italy. American goiter by its very appearance in non-mountainous regions of the United States contradicted nearly all of the received wisdom about the ailment's cause and potential cure. For two decades, American writers leveraged their own observations and local knowledge to challenge larger narratives in their field.

Goiter in Brazilian modernism paintings / Bócio em pinturas da arte moderna brasileira

Objective: To evaluate Di Cavalcanti's artworks in which goiters are represented before and after the introduction of iodized salt to the Brazilian population. Methods: One hundred and thirty paintings by Di Cavalcanti from the 20's to 70's demonstrating necks were evaluated. All the paintings were observed in reproductions. The neck circumference in the paintings was measured. Since there were no standard thresholds of neck circumference, cutoffs were based on the median. Baseline characteristics of artworks were compared based on high and normal neck circumference categories using Student's t-test, Mann-Whitney-Wilcoxon test, or chi square test. Results: We analyzed 29 artworks which portray the neck of 60 women (84.5%), 8 men (11.3%) and 3 children (4.2%). The analyses of the neck circumference showed 23.3% of women (14/60), 12.5% of men (1/8), and 33.3% of children (1/3) with an abnormal profile of the neck circumference. The neck circumference ratio in 29 paintings showed that the relative sizes of the necks painted between the 1920's and 1950's (r=0.45; p=0.03), and painted between the 1960's and 70's (r= 0.54; p=0.003) have linearly decreased. The decades in which the artworks were painted explained 40.0% of the variation in size of the neck circumference (p=0.002). Conclusion: Art imitates life. Di Cavalcanti was not a physician, and probably did not have the intention to illustrate a pathological condition, although the images observed in this study should be considered as goiter or enlarged neck.

Objetivo: Avaliar as obras de Di Cavalcanti em que bócios estão representados, antes e após a introdução da iodação do sal para a população brasileira. Método: Foram avaliadas 130 pinturas de Di Cavalcanti entre os anos 1920 e 1970 demonstrando pescoços. Todas as pinturas foram observadas em reproduções. A circunferência do pescoço nas pinturas foi mensurada. Como não existia limite-padrão da circunferência do pescoço, os limites foram baseados na mediana. As características básicas das obras de arte foram comparadas por categorias da circunferência do pescoço em elevadas e normais, usando o teste t de Student, o teste de Mann-Whitney-Wilcoxon ou o teste qui-quadrado. Resultados: Analisamos 29 obras de arte que representavam o pescoço de 60 mulheres (84,5%), 8 homens (11,3%) e 3 crianças (4,2%). Ao analisar a circunferência do pescoço, 23,3% das mulheres (14/60), 12,5% dos homens (1/8) e 33,3% das crianças (1/3) demonstraram perfil anormal dela. A relação da circunferência do pescoço em 29 pinturas demonstrou que as circunferências do pescoço relativas aos pescoços pintados entre os anos 1920 e 1950 (r=0,45; p=0,03) e pintados entre os anos 1960 e 1970 (r=0,54; p=0,003) reduziram linearmente. As décadas em que as obra foram pintadas explicaram 40,0% da variação no tamanho da circunferência do pescoço (p=0,002). Conclusão: A arte imita a vida. Di Cavalcanti não era médico e, provavelmente, não tinha intenção de ilustrar uma condição patológica, embora as observações das imagens, neste estudo, tenham sido consideradas como bócio ou com aumento de volume do pescoço

The representation of a goiter by Renaissance painter Moretto da Brescia.

Alessandro Bonvicino (c. 1498-1554), commonly known as Il Moretto da Brescia, was an Italian Renaissance painter. In his "The Adoration of Shepherds" (1539-1540), a shepherd shows a bi-lobar goiter. The painter was active in a geographical area, where inhabitants often suffered from endemic goiter due to dietary iodine deficiency and could have influenced Moretto.

[Iodine prophylaxis, voices from the past after 65 years]. / Yodoprofilaxis, 65 años después suenan las voces del pasado.

In 1953, Dr. Felipe Rodríguez Moreno joined the Granada Research Group on Endemic Goiter, which was led by Dr. Ortiz de Landázuri. A high goiter prevalence (62% in women) was found out within the area, and that prevalence was observed to be related to the dietary habits of the time, being the most disadvantaged those who were showing a greater prevalence. A relationship between the high goiter prevalence and the family of the subjects with goiter was also found out, as they usually had a first-degree relative with affection. Iodine content of drinking water was poor throughout the area, so the prevalence was not significantly different between individuals who drank from different water sources. There were only two females with cretinism and two males affected by "idiocy", so the goiters were probably euthyroid. After introducing iodine prophylaxis with iodized salt in Güejar-Sierra, prevalence decreased from 53% to 13% between 1953 and 1958.

En el año 1953, el Dr. Felipe Rodríguez Moreno se incorpora para continuar el trabajo sobre endemia bociosa de la escuela de Granada, liderada por el Dr. Ortiz de Landázuri. En ese paisaje descubre una alta prevalencia de bocio (62% en mujeres), que se relacionaba con el tipo de dieta consumida, de tal forma que los más desfavorecidos tenían una prevalencia de bocio aún mayor. Así mismo, se encuentra una relación familiar en cuanto al bocio, de manera que los sujetos con bocio normalmente tienen un familiar en primer grado también afectado. El agua de bebida es pobre en yodo de forma generalizada, por lo que no hay diferencias significativas en la prevalencia de bocio según la fuente de la que se surtan los paisanos.  Solo se encontraron dos mujeres con cretinismo y dos varones afectados de "idiocia". Por ello, cabe pensar que se trata de bocios normofuncionantes.  Tras iniciar yodoprofilaxis con sal yodada en Güejar Sierra, se produce un descenso de la prevalencia de bocio de un 53% a un 13% entre los años 1953-1958.

Yodoprofilaxis, 65 años después suenan las voces del pasado / Iodine prophylaxis, voices from the past after 65 years

En el año 1953, el Dr. Felipe Rodríguez Moreno se incorpora para continuar el trabajo sobre endemia bociosa de la escuela de Granada, liderada por el Dr. Ortiz de Landázuri. En ese paisaje descubre una alta prevalencia de bocio (62% en mujeres), que se relacionaba con el tipo de dieta consumida, de tal forma que los más desfavorecidos tenían una prevalencia de bocio aún mayor. Así mismo, se encuentra una relación familiar en cuanto al bocio, de manera que los sujetos con bocio normalmente tienen un familiar en primer grado también afectado. El agua de bebida es pobre en yodo de forma generalizada, por lo que no hay diferencias significativas en la prevalencia de bocio según la fuente de la que se surtan los paisanos. Solo se encontraron dos mujeres con cretinismo y dos varones afectados de «idiocia». Por ello, cabe pensar que se trata de bocios normofuncionantes. Tras iniciar yodoprofilaxis con sal yodada en Güejar Sierra, se produce un descenso de la prevalencia de bocio de un 53% a un 13% entre los años 1953-1958 (AU)

In 1953, Dr. Felipe Rodríguez Moreno joined the Granada Research Group on Endemic Goiter, which was led by Dr. Ortiz de Landázuri. A high goiter prevalence (62% in women) was found out within the area, and that prevalence was observed to be related to the dietary habits of the time, being the most disadvantaged those who were showing a greater prevalence. A relationship between the high goiter prevalence and the family of the subjects with goiter was also found out, as they usually had a first-degree relative with affection. Iodine content of drinking water was poor throughout the area, so the prevalence was not significantly different between individuals who drank from different water sources. There were only two females with cretinism and two males affected by «idiocy», so the goiters were probably euthyroid. After introducing iodine prophylaxis with iodized salt in Güejar-Sierra, prevalence decreased from 53% to 13% between 1953 and 1958 (AU)

Historical aspects of iodine deficiency control.

In 1895, iodine was characterized as an essential element of thyroid tissue by Baumann. The efficacy of iodine to prevent goiter was demonstrated by Marine in Northern USA in 1916-1920. Severe endemic goiter and cretinism had been almost entirely eliminated from continental Western Europe and Northern America before the 1930's; however large populations elsewhere and even some places in Western Europe (Sicily) were still affected up to the 2000's. Public health consequences of iodine deficiency are not limited to endemic goiter and cretinism. Iodine deficiency disorders include also increased neonatal death rate and decreased intellectual development, although these consequences are not included in the current estimation of the Global Burden Disease related to iodine deficiency. Severe iodine deficiency as a public health problem is now largely under control worldwide, but can still affect isolated places, in hard-to-reach and/or politically neglected populations. We emphasize the importance of maintaining international cooperation efforts, in order to monitor iodine status where iodine deficiency is now adequately controlled, and identify at-risk population where it is not. The goal should be now global eradication of severe iodine deficiency. Commercial distribution of iodized salt remains the most appropriate strategy. A randomized clinical trial in New Guinea clearly showed in the 1970's that correcting severe iodine deficiency early in pregnancy prevents endemic neurological cretinism. This supports the essential role of thyroid hormones of maternal origin on the normal fetal development, during the first trimester of pregnancy (i.e. when fetal thyroid is still not functional). A randomized clinical trial in Congo (RD) in the 1970's also showed that correcting severe iodine deficiency during pregnancy prevents myxœdematous cretinism, particularly prevalent in affected Congolese areas.

[From Geomorphological Research in the Canton of Aargau to European Military Pathologies. Entangling Anthropological Discourses of Crisis through the Army, 1860-1900]. / Von der Geomorphologie des Aargau zu den militärischen Pathologien Europas. Das Militär als Schnittpunkt anthropologischer Krisendiskurse, 1860-1900.

Military statistics and medical research were closely related over the 19th century. The army not only made use of these new forms of knowledge, but also provided an important institutional setting through the military medicine, which was of crucial importance to medical research in the 19th century. Besides that, Swiss military also played a crucial role in new geographical and geological research, resulting in a series of new mapping projects. This article looks on the ways, in which military context gained influence on scientific research practices in the second half of the 19th century, by analyzing the case of Heinrich Bircher's work on military recruiting statistics and the endemic goiter. New mapping projects and statistical practices were linked, transforming big parts of the country into pathological spaces. Coming from this point, the article discusses in how far the military context lead to politicizing medical discourses and, furthermore, linked them to discourses of an anthropological crisis, common in many European countries.

Iconography of goiter: four refined examples in the Sacred Mountain of Varese, Italy.

BACKGROUND: Four goiter representations observed by the authors in the sculptures of the Sacred Mountain of Varese, Italy, are described here. SUMMARY: They should be regarded as a typical and proper example of the iconography of "real goiter," where the artists had the definite intention to depict persons with goiter. CONCLUSIONS: Studies of representations of individuals with goiter are not that rare, even though most of the observations reported in the literature deal with images that should be considered occasional swelling of the anterior neck, "thick neck," or "pseudogoiter" because the artists probably did not have any intention to illustrate the pathological condition.

O sal como solução? Políticas de saúde e endemias rurais no Brasil (1940-1960) / Salt as solution? Health policies and endemic rural diseases in Brazil (1940-1960)

O objetivo deste artigo é analisar e comparar as políticas acerca do uso do sal no tratamento de duas doenças graves que assolaram a Amazônia e as áreas rurais do Brasil durante o período desenvolvimentista: o bócio endêmico e a malária. Apesar de serem doenças muito diferentes – a primeira é uma doença carencial, e a segunda uma doença parasitária – a luta dos médicos e nutricionistas para tornar obrigatória a iodação do sal de cozinha consumido no país inspirou aidéia de um sal misturado com cloroquina, a ser distribuído livremente em zonas de malária, onde o uso de DDT (Dicloro-Difenil-Tricloroetano) não seria eficaz. O que seria um método simples – e, portanto, eficaz – para controlar e até mesmo eliminar tais doenças, o uso do sal de cozinha como veículo para fornecer iodo e uma droga antimalárica para a população, esbarra em fatores cognitivos, econômicos, sociais e culturais. Algumas variáveis contribuem para a análise histórica desses programas de saúde: o consenso quanto à etiologia da doença, o grau de institucionalização da comunidade de especialistas e a sua organização, a importânciada doença na agenda das organizações internacionais de saúde, o locus dedecisão política, a existência de uma liderança científica envolvida na formulaçãoe gestão das políticas de saúde, e os padrões de consumo das populações-alvo. (AU)

INCAP studies of endemic goiter and its prevention.

The high prevalence of goiter among adults in its member countries of Central America and Panama was observed as soon as INCAP began field studies. This led to systematic studies of goiter in schoolchildren in all of the countries as described, beginning with Guatemala where the rate was 38% nationally. However, efforts to eliminate the consequences of iodine with iodized salt using the water soluble potassium iodate and a process that had proved successful in Switzerland and the United States could not be used with the crude moist salt of the region. INCAP identified potassium iodate that is insoluble in water, and in four schools (two each in El Salvador and Guatemala) proved that the iodine in this compound was as available as that in potassium iodate. It remained evenly distributed in moist salt. When added to salt in Guatemala, goiter rate dropped to 15% in four years and less than 5% in eight years. Compulsory iodation of salt in other developing countries followed with comparable results. This method is now used in worldwide campaigns against iodine deficiency in developing countries.

[Research and cure: knowledge and prophylaxis of endemic goiter in Argentina (1916-1958).]. / Investigar y curar: conocimientos y profilaxis del bocio endémico en la Argentina (1916-1958).

The present paper focuses on the reconstruction of the historical circumstances of knowledge production as well as and the debates about endemic goiter disease during the period 1916-1955 in Argentina. Taking into account the social, political and material dimensions, this text explores the re-signification of scientific and medical knowledge oriented to the prevention and health treatment, through the positioning of several social actors engaged all along the period, and the diverse historical and institutional contexts.

Sobre papos, águas, barbeiros e iodo: a história do bócio endêmico em Minas Gerais / About goitres, water, Triatomas Infestans and iodine: the history of the endemic goiter in Minas Gerais

Neste texto, destacam-se duas informações que marcaram a compreensão da enfermidade por muito tempo. A primeira é que a doença procedia das águas que se bebia em alguns sítios; a segunda é que 'é a gente dessas partes muito sujeita a essa doença'. A atribuição da causa da moléstia às águas não explicava por que uns teriam mais papos do que outros. Já a informação de que era uma doença comum entre os moradores da região de Minas Gerais e São Paulo indica seu caráter endêmico. (AU)