164

Portsmouth, Royal Portsmouth Hospital.-Cas. O. At rate of £100.Prinres.s Louise Kensington Hospital fur Children, North

Kensington.—Hon. Asst. Surg.Queen’s Hospital for Children, Hakney-road, E.-Asst. Surg.Rochester. Kent, St. Bartholomew’s Hospital.-H.P. At rate of

£175.

Royal Army Medical Corps.-Twenty-five Commissions. £500to £2000.

Royal London 0_1)hthalmic Hospital, City-roacl, E.C.-Three Out-patient Officers. Each £100.

Royal Waterloo Hospital for Children and Women, Waterloo-road,S.E.—Hon. Clinical Asst.

- Rydf. Royal Isle of Wight County Hospital.-Vacancy on Hon.Medical Staff.

Salisbury, General -Tnftrmary.-Res. M.O. £150.St. Mark’s Hospital for Cancer, &c., City-road, E.C.-H.S.

At rate of .87 a.St. Mary’s Hospital for Women and Children, Plaistow, E.-

Res. and Asst. Res. M.O.’s. At rate of £175 and 120respectively.

St. Marylebone General Dispensary, 30, Marylebone-lane, W.—Dental Surgeon to L.C.C. School Dental Clinic.

Torquay, l’orbay Hospital.—Hon. Obstetric Physician.West London Hospital, Hammersmith-road, TT’.-Hon. Obstetric

Registrar.Woolufch and District War Memorial Hospital, Shootrs’ Hill

S.E.-H.S. At rate of £125.Worcester County and City Mental Hospital, Powick.—Jun. Asst.

M.O. £350.

The Chief Inspector of Factories announce vacancies forCertifying Factory Surgeons at Rugby (Warwickshire),Welwyn (Herts), Holmfirth (Yorks), and at Syston (Leics).

A vacancy is announced for a Medical Referee under theWorkmen’s Compensation Act for St. Albans, Barnet,Hertford and Watford, Circuits 37 and 38. Applicationsshould reach the Home Office not later than Feb. 2nd.

Births, Marriages, and Deaths.BIRTHS.

ELKINGTON.—On Jan. 10th, at Stockwell House, Bruton, thewife of Dr. Guy Elkington, of a son.

REID.—On Jan. 10th, 1929, at Burntwood, Lichfield, Staffs, toDr. and Mrs. William Reid-a daughter.

MARRIAGES.GOSTWYCK—DAWSON.—On Jan. 9th, 1929, at St. Mark’s Church,

Connah’s Quay, Flint, by Rev. E. J. Davies, Cecil HubertGostwyck Gostwyck, M.B., F.R.C.P., D.P.M., DeputyMedical Superintendent, Rampton State Institution,Retford, Notts, son of late Lt.-CoI. W. G. Gostwyck,2nd Batt. Argyll and Sutherland Highlanders, to Brenda,youngest daughter of the late Ralph Mainwaring Dawson, ofFulwood Park, Liverpool, and Mrs. Dawson, KelstertonHall, Flint.

DEATHS.BENNETT.-On Jan. 13th, at Upper Berkeley-street, W., Henry

Selfe Bennett, M.B. Camb., aged 81.BOYD-WALLIS.—On Jan. 7th, at Leas Court-mansions, Folkestone,

Albert William Boyd-Wallis, M.R.C.S., L.S.A., in his 90thyear.

EVANS.—On Jan. 12th, at his residence, Hampstead House,Seaford, Herbert Norman Evans, M.A., M.B. Oxf.,aged 93.

HARTLEY.—On Jan. lst, Francis William Hartley, M.R.C.S.,L.R.C.P., of Heywood, Lancashire, aged 63 years.

SIMPSON.—On Jan. llth, John Watson Simpson, M.B., Ch.B.,D.P.H., of Snitterfield, Stratford-on-Avon.

WATSON.—On Jan. 4th, suddenly, at Strathearn-place,Edinburgh, Major Alexander Oswald Cowan Watson,R.A.M.C. (retired), of Carden-place, Aberdeen.

N.B.-A fee of 7s. 6d. is charged for the insertion of Notices ojBirths, Marriages, and Deaths.

INDEX TO " THE LANCET,"VOL. II., 1928.

THE Index and Title-page to Vol. II., 1928, whichwas completed with the issue of Dec. 29th, is now inpreparation. A copy will be sent gratis to subscriberson receipt of a post-card addressed to the Managerof THE LANCET, 1, Bedford-street, Strand, W.C. 2.Subscribers who have not already indicated theirdesire to receive Indexes regularly as publishedshould do so now.

Notes, Comments, and Abstracts.IODINE IN RELATION TO GOITRE.

BY D. W. CARMALT-JONES, M.D. LOND.,F.R.C.P. LOND.,

PROFESSOR OF SYSTEMATIC MEDICINE, UNIVERSITY OF OTAGO, NEWZEALAND; CONSULTING PHYSICIAN, WESTMINSTER HOSPITAL.

PART II.*

Goitre Incidence and Soil Iodine.If it be true that endemic goitre depends on the poverty

of the soil in iodine. then an inverse ratio should existbetween the amount of iodine in the soil and the incidenceof goitre in any series of districts examined. In such aninvestigation there are several evident sources of error.It can only be true if iodine deficiency is the only possiblecause of goitre, if the iodine available for ingestion is derivedexclusively from the local soil, and if perfectly uniformobservations are made on all cases examined. These con-ditions are not realised in practice. Nevertheless, a verysearching inquiry has demonstrated a remarkable associationbetween iodine deficiency in the soil and the incidence ofgoitre in school-children. As stated above, over 90,000children were examined in 33 districts, from each of whichsamples of soil were analysed, with about 500 analyses in all.Hercus, Benson, and Carter summarise their results as

follows : " The figures for goitre incidence and soil iodinehave been plotted as ordinates and abscissae respectively...and a smoothed curve has been drawn through the pointsobtained. So closely do most of these points lie to thecurve that it is apparent that an intimate connexion mustexist between the amount of iodine in the soil and theincidence of goitre." A few instances only can be givenhere. In South Canterbury over 5000 children were

examined, 62 per cent. of them had goitre, and the soilcontains 4 parts of iodine per 10’. In Taranaki, again morethan 5000 children were examined ; Taranaki soil contains166 parts of iodine per 107, and the incidence of goitre was7 per cent. These are the extreme cases. As an inter-mediate instance, Wellington soil has 40 parts of iodineper 10’, and 25 per cent. of goitres were found in more than2500 children. With rare exceptions, a similar inverseratio is found throughout the country. The very difficultchemistry in these observations was carried out by Mr. C. L.Carter, M.Sc. The geological problems involved were

investigated by Prof. W. N. Benson, and a single instanceof the observations made must suffice. Canterbury has avery high goitre incidence ; the Canterbury Plains consistvery largely of river gravel with very little colloid, andcontain nothing to hold soluble salts against leaching.The plains are crossed by many great rivers and the soil isvery thoroughly leached ; this. no doubt, accounts for thesmall amount of iodine in it, which is accompanied by a60 per cent. incidence of goitre in school-children living onthe products of the soil.The establishment of this inverse ratio between goitre

incidence and soil iodine is evidently of great importance inthe inquiry into the aetiology of endemic goitre. It does not,however, indicate how the iodine is obtained by animals,whether by food or water, and a further research was con-ducted by Hercus, in association with K. C. Roberts aschemist, into the iodine content of foodstuffs raised oniodine-rich and iodine-poor soils respectively. This estab-lished that the essential iodine is normally derived fromfoods, though a deficiency may on occasion be made goodby a water-supply which happens to contain iodine fromany source such as iodine-bearing rocks or, as in the caseof Lyttelton, from the sea. Such instances are, however,quite exceptional.

The research is of the first importance in the rationalpreventive treatment of endemic goitre, since it lays par-ticular emphasis upon the minute amounts of iodine which

* Part I. appeared last week.