REPRINTED EROM 
UNIVERSITY 
Medical Magazine. 
EDITED UNDER THf AUSPICES OF THE ALUMNI AND FACULTY QF MEDICINE 
OF THE UNIVERSITY OF PENNSYLVANIA 
BDITOr.IAL STAFF 
CONTENTS. 
nucz. »aoO ju XN 
JANUARY, 1896 
RACIAL DEGENERACY IN AMERICA; GOITRE AND 
DWARFING. 
BY ALBERT S. ASHMEAD, M.D., 
NEW YORK. RACIAL DEGENERACY IN AMERICA; GOITRE AND 
DWARFING. 
Albert S. Ashmead, M.D., 
Racial degeneracy may be defined as non-resistance to influ- 
ences inimical to the existence of the race. The individual who can- 
not resist the disease-producing causes which are afloat, whether they 
be germs, climate, or whatever their nature, is physically degenerate. 
If the subject has lost all power of resisting the immoral tendencies 
which threaten the race, he is morally degenerate. A cretin is intel- 
lectually degenerate. A dwarf is a degenerate, because he has lost 
the faculty of growth. 
Goitre is a disease of racial degeneracy; it will only be found in 
those races in whom development has come to a stand-still, as the 
mixed races of South and Central America, the Cagots, some inferior 
layers of the Scotch, the mixed mulatto race, and the degenerate 
Indians of America, etc. 
Leprous races are degenerate, as the Eta race of Japan, some 
Central and South American races; the low caste Hindoos; the 
poorer element of the Norwegian people. These diseases-leprosy, 
goitre, dwarfing, cretinism-are evidences of the dying out of a race. 
Hirsch says, Endemic goitre and cretinism exist from the basin 
of the Rio Grande del Norte (New Mexico) extending along the Cordil- 
leras through Mexico, Central America, and South America as far as 
Chili. In the mountains of Mexico, Colima, western slope of Cordil- 
leras, and in Tobasco and Chiapas, thence into Gualemita in the 
tierra templada of which there are whole villages afflicted with goitre, 
and thence outward through San Salvador, Nicaragua, and Costa 
Rica. Paraguay has goitre in its river basins. It exists also in the 
Southern and Central provinces of Brazil,-as Rio Grande, Santa 
Caterina, San Paulo, Goyaz (both the west and east slopes of Sierra 
Geral in Natividad Congeicao, Arrayas, Villa-Boa, and upper basin of 
Parahyba and Minas Geraes, districts of Barbacena, Ouro-Preto, Sahara, 
and others) : all over the country, except coast territory and alluvial 
plains. Rendu, St. Hilaire, Castlenan, and Tschudi say cretinism does 
not occur endemically anywhere in Brazil. Dr. Faure, who lived for 
a long time in central province (head-quarters of goitre), says he never 
saw but one case of cretinism. 
Cretinism is endemic in New Granada, which is also the chief seat 
of goitre. Both diseases occur throughout almost the whole valley 
of the Rio Magdalena from Neyva in the tierra fria downward through 
New York. 2 
Albert S. Ashmead. 
Santa Fe de Bogota, Maraquita, Honda, and other districts as far as 
the plain of Pinto, at the confluence of the Cauca and Magdalena. 
Neither in the lower basin of the latter river, nor in the parallel valley 
of the Cauca, nor in the mountainous province of Antioquia, between 
the two, do goitre and cretinism occur, but we again come upon them, 
in endemic form, in the basins of the Meli and Apure. Foote found 
hardly a person in Maraquita not subject to goitre more or less. 
Magdalena Valley has also cretins. In Venezuela goitre occurs on the 
plain between Caracas and Valencia (St. Lager) and in mountain 
range from Barquicimeto, as far as Pamplona and frontier of New 
Granada. The basin of Orinoco is free of goitre (Humboldt). No men- 
tion of goitre and cretinism in Guiana. From New Granada the zone 
runs down the Cordilleras through Quito, Cuenca and Loxa to Cuxa- 
marca, Huamacucho, Huanuco, and Pasco, in the valley of Hualoga, 
through central valleys of Peru, particularly valleys of Libertad and 
Ayacucho. Cretinism is not indigenous there (Archibald Smith). 
Tschudi makes no mention of it. In Bolivia the chief seats are the 
provinces of Yungas and Ayopaya. In Chili, endemic in San Felipe, 
Santiago, and other places. In the states of the Argentine Republic 
goitre finds its evident distribution in the provinces of Salta, Jujuy, 
Tucuman, Los Lueles, La Rioja (particularly Famatina Valley), and 
Mendoza, in some districts of the provinces of Cordova and San Luis, 
and many places in the states of Corrientes and Entre Rios. Mante- 
gazza says cretins occur with goitre in Salta. 
Gache1 says among the endemics of the Argentine Republic 
goitre is one of the most frequent. 
The cause of this affection has been sought in the geologic na- 
ture of the different soils, but this idea had to be given up, because 
it was found to develop on soils of a variety of nature. It has been 
searched for, with better reason, in the chemical composition of the 
waters, and the studies made in that direction have not been satisfac- 
tory either. 
It has been attributed to the want of oxygen, of iodine, and bro- 
mine in the water; the waters in which magnesia represents 25 per 
cent, of the total of the salts have been thought of; fluoride of lime 
has been also thought of as a cause, but we can only consider all these 
opinions as individual appreciations of isolated facts establishing 
contradictory results, since the same disease has been discovered in 
conditions essentially different. 
Melted snow waters, says Boussingault,2 are considered by some to 
be a cause of goitre for such persons as are obliged to use them. As 
1 Climatologie M6dicale, Buenos Air£s, 1895, par le Dr. Samuel Gache, translated by A. S. 
Ashmead. 
2 Voyages scientifiques aux Andes equatoriales, 1849. Racial Degeneracy in America. 
3 
a matter of fact, in New Granada, this disease is observed in the 
countries whose inhabitants drink, as a rule, this kind of water, also 
in the city of Mariquita, situated on the bank of Guali, which issues 
from the snowy peaks of Ruiz, and in the city of Ibague, on the banks 
of the Combeyma; but the largest number of the localities in which 
the goitre is endemic is very far from the snows, and the waters which 
their inhabitants drink are not melted snow. 
It has been also supposed that spring waters might be the cause 
of the disease, on account of their low temperature and of the saline 
matters which they contain. 
The same author, referring to the observations made in the country 
quoted, says that he knows only two localities in which the inhabi- 
tants drink exclusively spring water; these are,-Nemocon, in the 
province of Bogota, which possesses an abundant source, issuing 
from a sandy rock, and the city of Socorro, whose inhabitants drink a 
spring water spouting from calcareous rock. 
In this last country goitre is very common, and it becomes very 
voluminous, while not one is seen in Nemocon. 
We are consequently in the presence of two facts. The waters 
which run across insoluble rocks of quartz do not exercise any action 
upon the thyroid body, and the persons who drink the water issuing 
from calcareous rock, partly soluble on account of the carbonic acid 
which it contains, see the same body become hypertrophied, and 
attain a very great development. Hence the problem whether the 
geologic nature of the soils which waters traverse has or has not an 
influence upon that organ. 
This problem has been resolved by numerous authors, who have 
declared, after serious studies, that, with the exception of the cal 
careous rocks, the nature of the soil does not seem to have any influ- 
ence on the frequency of goitre, and that if that influence really 
exists, it is only exercised in the countries of secondary calcareous 
rocks, and in the majority of the countries where goitre is endemic 
there are no such rocks. The theory according to which the water 
issuing from snow, or descending from high mountains produces 
goitre, and that it loses this power as it flows away from its source 
and absorbs the air which it needs, is upset by this fact, that in low 
countries in which the people make no use of mountain water, goitre 
is, nevertheless, steady and even very common. Important centres 
might be mentioned where the water used from its origin must con- 
tain very little air, and in which you meet only exceptionally a goitrous 
person. 
Boussingault reports that these last facts have been proved in 
places peopled by Indians, a race which, in all America, appears to 4 
Albert S. Ashmead. 
be immune of that affection; at any rate, he adds, " I have never 
seen one of pure race having a goitre. In Coloya, in Piedras, and on 
the banks of the Combeyma that tumor is very frequent among the 
negroes, the mulattos, the Metis, but the Indians are not subject to 
it, although they make use of the same waters. Before me, a cele- 
brated traveller had made the same observation. The indigenies 
with bronzed skin enjoy, says Humboldt, a physical advantage due 
without doubt to the simplicity of the mode of life of their ancestors 
during thousands of years. I have never seen an Indian hunch- 
backed, and I have encountered rarely in them those who were 
squint-eyed, lame, or maimed. In the countries where the inhabitants 
are exposed to goitre, the Indians are not attacked by this disease, 
which one observes only rarely in the Metis." 
According to Bordier, Indians are in the Andes subject to goitre; 
the Metis less so; after the Metis come the whites, and the negroes 
bring up the rear. As may be seen, these data are different from the 
preceding. 
The local observation accords with that of Bordier. It has been 
said that the Quechua Indians of Jujuy are exempt from it, but the 
truth is that in that province the Indians are attacked by the affec- 
tion, as we shall see hereafter. 
The studies of Grange have in their time thrown light on this 
obscure point in the etiology of the endemic of which we speak. 
They have pointed out that in all the valleys where it reigns, the 
drinkable waters, whatever be the earth upon which they flow, con- 
tain a large quantity of chlorides, of sulphides, and carbonate of mag- 
nesia. From his point of view, it is the absence of lime in the waters, 
rich in magnesia, which causes goitre. He proposes to pass these 
polluted waters through filters or deposits filled with carbonate of 
lime or a very thin layer of lime. 
The chemical study of the earth of the regions in which goitre is 
rampant, according to certain authors, does not give either, it seems, 
much foundation to the theory which seeks in the elements that com- 
pose them the origin of the disease. 
Could one not base a suspicion on some action exercised by a 
special element belonging to the earths on the waters over which they 
pass, which might contribute to explain the genesis of this disease ? 
A bacteriological examination of these earths might clear up the 
question by determining the kind of germ which acts in these cases. 
After having repelled the theories which have been put forth to 
establish more or less scientifically the etiology we seek, and having 
recognized with Baillarger that there exists a special agent, unique, 
always the same, which affects the organisms and impresses upon Racial Degeneracy in America. 
5 
them a mark of degeneration always identical, of which the first 
stage is goitre, and the last cretinism, one ought to find this agent in 
order to prove the opinion of Arnold as to the question whether the 
cause resides in some of the known elements of the waters or in 
some other which is not known. 
One may, perhaps, according to this author, consider parasitism, 
but it will be necessary to recognize the bacterium of goitre. 
This has indeed happened. 
A short time after the predictions of the French savant, Drs. 
Lustig and Carle published the results of some studies which they 
had made of the waters of the valley of Aoste, where goitre is endemic, 
and they have established the following conclusions : 
(1) All the waters examined which in places visited served for 
drinking of for domestic uses to the inhabitants affected by goitre 
are very rich in bacteria. 
(2) Constant presence in varying quantity of a bacillus, which 
liquefies gelatin, and which has special morphological and biological 
characters. 
(3) The experiments made upon horses and dogs absolutely 
healthy, by making them drink that water in a district exempt of 
goitre, have demonstrated to us that the water has incontestable 
power to produce an augmentation of the thyroid gland. 
(4) It is not yet demonstrated that the elimination of the 
microbes takes away from that water the property engendering goitre. 
The etiology of goitre finds itself thus well established, and the 
prevision of Arnold is confirmed by the application of the microbian 
theory. 
The goitrous bacterium is found in the water, but it is necessary to 
search for its origin in order to establish definitely the importance 
that the soil and the water may have in that complicated etiology. 
Is it not in the soil, that germinates the marsh hematozoin ? 
It is reasonable to suppose that the bacterium takes birth in the 
soil, if we base ourselves on the following fact: that the waters 
causing goitre have not that virtue throughout the extent of their 
course, and one can determine the commencement and the end of 
their action. 
But it is necessary to recur to the experimental demonstration. 
Formerly, great etiological importance was attached in the first 
place to heredity, to genitality, altitude, etc. 
It is very possible that all these circumstances contribute to pro- 
duce the disease by preparing the soil that the bacterium will presently 
fecundate ; but, above all, it is necessary to recognize the direct action 
of the latter, whatever may be its starting-point. 6 
Albert S. Ashmead. 
Bordier, who has studied specially these questions of medical 
geography, says that goitre is found especially in the mountains in 
cold countries, as in hot countries the essential condition was a 
sojourn in the mountains. 
At the last Congress of the French Association for the Advance- 
ment of the Sciences (Session of Pau, September 21, 1892), Chopinet, 
of Leronville, has expounded his own ideas on the subject of goitre 
and cretinism, and has presented the following conclusions : 
(1) It is in the bottom of the valleys in the neighborhood of 
brooks that are observed almost exclusively these two symptoms of 
the same disease. 
(2) The endemic increases continually in intensity from the be- 
ginning of the valleys to the last contreforts of the chain (Pyrenees). 
Its maximum is in the broadest parts of the valleys. 
(3) The endemic tends to become attenuated in a general way; it 
has even disappeared in several localities formerly very much affected. 
It is not to a change in the nature of the drinking waters that one 
can attribute this recoil of the disease, but rather to the progress of 
general comfort and of general hygiene. 
(4) It is not only the slatey limestone which, in the geologic con- 
stitution of the soil, plays a part incontestably obnoxious. 
(5) Very numerous causes of goitre and of cretinism are, for the 
Pyrenees especially, humidity and the uncleanness of the houses, the 
defect of aeration and of solar light, the bad alimentation. 
(6) In the Pyrenees there is considered only one doctrine to 
which the facts give not the lie. It is the doctrine that goitre has a 
great variety of causes. 
At the same congress, Gils connected the origin of the disease 
with micro-organisms, saying that since it had been able to show itself 
momentarily and then disappear in countries where it was unknown, 
it is logical to attribute its cause to a living principle susceptible of 
acquiring or of losing its poisonous character ; in consequence, goitre 
would enter into the general category of diseases produced by micro- 
organisms, and could, under certain influences, extend and propagate 
themselves by their invasion. 
The question of soil or of composition of waters in countries 
where goitre rages, would be reduced, according to Gils, to a question 
of medium of culture, proper to the development of the micro-organ- 
ism, and in these conditions the affection does not appear fatally in- 
herent to a region susceptible of being modified only by a geologic 
revolution, but rather an affection of medium of which hygiene should 
get the better. The microbian theory applied to the etiology of 
goitre gains ground, and thus are confirmed the predictions of Arnold. Racial Degeneracy in America. 
7 
In the Argentine Republic we see goitre develop itself as quickly 
in the mountainous countries, such as the provinces of Mendoza, San 
Juan, Tucuman, Salta, and Jujuy, as in Corrientes, remarkable for its 
plains covered with an abundant vegetation. 
If it prevails in the first because the territory is mountainous, 
what reason can be proposed to justify its presence in the other 
which is far, very far from the mountains ? 
We cannot draw an argument from the fact that the small number 
of cases which appear at Corrientes is a proof of the influence of 
altitude, because, if to-day the number of persons attacked is rela- 
tively limited, on the other hand, that affection has made formerly 
numerous victims in the same place. 
There were found at other times a large number of goitrous in some 
little villages of Corrientes, situated on the river Uruguay, who 
seemed to have contracted the disease by drinking well water instead 
of the water of the river, which is infinitely superior. 
The elimination of the disease in that province is evident, and it 
is not possible to attribute it to any modifications which might have 
been produced in the general conditions of the soil, in the vegetation 
or in the water. 
Has some unknown focus been destroyed ? It appears to us 
more acceptable to admit the action of the crossing of races, which 
takes place in the countries of the littoral, which strangers prefer, 
carrying with their blood new forces, better dispositions for the 
struggle for life, and even a greater vigor in resisting the action of 
the climate and special vicissitudes of each locality. 
How is it that San Juan, which is surrounded by the Andes, as 
well as Mendoza, has freed itself of the goitre ? How is it that San 
Luis, in the same condition, is not subject, while Mendoza pays large 
tribute to it ? 
The reason is that there is something more than influence of 
altitude, in these facts. 
It is no longer possible to point to defect of aeration of the 
water, because when it comes to be consumed it has run through a 
space of several hundred kilometres. 
The most favorable condition is, without doubt, the sojourn in a 
mountainous region; the different circumstances, and the climatic 
agents are the elements which enter into that condition. One must 
consider the waters which traverse the soils of different constitu- 
tion, which have in dissolution or in suspension the principles which 
they have taken from them and which it behooves us to study in 
detail. 
In our country, goitre does not appear only in mountainous 8 
Albert S. Ash mead. 
regions, but it appears even in localities which are far removed from 
the mountains, and for which it is not necessary to take into account 
the altitude, which is insignificant. 
That condition is therefore not primordial for the production of 
goitre, although it exercises some action, and although the endemic 
is frequently found in mountainous districts. 
Let us see now its frequency in the Argentine Republic. 
At Mendoza cases are numerous, principally among women. 
In 1879, there were in the city 245 women and 65 men attacked 
with goitre. 
There exists in that province, at a short distance from the capital, 
a canton called San Vicente, where this disease is so common that 
among the inhabitants of the other villages the name of Vicentino is 
synonymous of goitrous for the multitude. Whoever has seen this 
land must remember the enormous number of these unfortunates. 
One meets them in all sections of that province, and, according 
to Dr. A. Lemos, the proportion varies between 8 in 100 inhabitants, 
as at San Vicente, and 1 in 100 at Lujan, while San Martin and the 
capital represent an average of 3 in 100. 
The proportion is, perhaps, exaggerated as to the last place, but 
it is not so for the other districts named. 
Thus, Mendoza would find itself in conditions similar to those of 
several departments of France, in which the proportion of goitrous is 
7.3 per 100 inhabitants, while in others it is 3 and 1 per 100. It has 
been calculated that France conta'ins 500,000 persons affected by this 
deformity. 
In San Juan the disease disappears with such rapidity that it is 
rare to meet a goitrous. The same is an exceptional occurrence at 
San Luis. 
The contrast presented by the provinces just mentioned is re- 
markable, the endemic is very frequent at Mendoza, almost nothing in 
another province, in a third nothing at all. However, in each we 
observe the influence of altitude, vegetation, the abundant waters, 
and even the absence of the foreign element which, by its crossing 
with the national element, would give, as a result, a modification of 
type, which would be favorable to the disappearance of the disease, 
because it would produce subjects less apt to contract it. 
On the other hand, in the Argentine provinces of the north, 
goitre takes alarming proportions. We find it at Tucuman, especially 
in the capital (in the south), and in the environs, Tafi, Javier, and 
Yerba Buena; it is observed also frequently at Lules, Famailla 
Monteros, as well as at Francas, San Pedro de Colalao, Graneros, 
Chichigasta, and Rio Chico. In the zone corresponding with the 
Calchaquics Valleys, the disease has not been observed. Racial Degeneracy in America- 
9 
That of Salta counts some regions in which the affection consti- 
tutes a veritable scourge. The strongest contingent is furnished by 
the departments of the capital, Cerrillos, Chicoana, Caldera, Rosario 
de Lerma, Guachipas, and Campo Santo,-that is to say, it is the 
country which forms the valley of Lerma, which pays the most con- 
siderable tribute to the endemic. There exist some villages in which 
one-half of the inhabitants are attacked, as at Calderilla, for example ; 
Guemes and Santa Rosa are very much stricken. The city presents 
numerous cases disseminated among all social classes. According to 
Dr. Nino, that malady can be traced back in that city to an epoch very 
remote; it is, on the contrary, of recent date, if one compares it to 
its ancientness in the rest of the district. In his opinion, it is to be 
explained by the modifications undergone by the waters of the river 
Arias, which furnishes the drinking water of the inhabitants. 
According to Dr. Nino,1 this river, in consequence of ancient 
floods, has augmented the bulk of its waters by the addition of those 
of Silleta. Since that epoch, goitre has made its appearance in the 
capital. There is no doubt on this head, since in the epidemic of 
cholera, in 1886 and 1887, it has been established that as long as the 
inhabitants made use of boiled water, the goitres have diminished 
in volume, at the same time intermittent fever ceased its invasions. 
We readily conclude from this fact that the second of these rivers 
contains some principle or morbid germ, which, by its action on the 
organisms, produces the endemic. That supposition is corroborated 
by the observation that the district of Silleta is that which furnishes 
the most marked cases of goitre. Therefore we must study the com- 
position of the waters of the last river and make bacteriological 
examination of them. If the fact observed is evident, as we suppose, 
and if it is true that before the junction of the waters of these two 
rivers the malady in question was not known in the city of Salta, it is 
urgent to make researches in the waters of the first and in the soils 
which it traverses for the cause of the evil. 
Bacteriology must make this clear. It alone can decide in the 
last instance, by a reasoning based on the practical demonstration, 
the good foundation of these opinions, which, in our eyes, have a very 
serious character. 
In the province of Jujuy goitre is observed in the following 
departments : San Pedro, Perico, the southerly part of Valle Grande, 
and Ledesma; this last is most stricken. It follows that the endemic 
reigns in the villages situated in proximity to the river Grande. 
There is an evident tendency to a diminution. 
1 Francisco R. Nino, Geografic M&iica del b6cio en la Republica Argentina, t£sis, Buenos Air£s, 
1890. 10 
Albert S. Ashmead. 
In the province of Catamarca the goitrous region comprises the 
capital, Pedra Blanca, and Poman. In this last department the river 
Belen disappears; the two others are watered by the river of the 
Valle, which ends at Capallan. 
Andalgala and Belen are likewise very much visited by the dis- 
ease. 
Dr. F. de la Vega believes that the consanguinity very frequently 
found in that province is an important element which acts on the 
etiology of goitre. The proportion between goitrous men and women 
is one for the first against ten for the second. 
In females who have not had children, the march of the affection 
is slow, while it is very rapid in multipara. 
In the south of the valley of Catamarca, on the banks of the 
great river Salinas, there have been discovered in several estancias 
(stations) some wells whose slightly saline waters have the property to 
destroy the hypertrophy of the thyroid gland, after a use of some 
months, when the tumor was not very much developed. 
It is supposed that these waters contain iodine and bromine, but 
no serious analysis practised has established the presence of these 
metalloids. 
In the province of La Rioja it has rather frequently been observed 
in a little village of the department of Chilecito, in the bottom of a 
valley where the waters are calcareous, like the greater part of those 
of the region. 
There exist in this district whole families of goitrous, who 
marry with other goitrous, and whose children are attacked with 
the same disease. It is necessary to add that some families who have 
come to live in this country have remained exempt, as well as their 
children. This would constitute an argument in favor of heredity, if 
facts well proved did not show that individuals exempt of all hereditary 
disposition are victims of the endemic. This is a general observation. 
The diminution of goitre when the diseased is removed from the 
endemic point, and its augmentation when he comes back to it, have 
been the subject of serious researches which have established this 
fact. 
The following is a table of the frequency of goitre in the Argen- 
tine Republic, according to the data of the census of 1869 : Racial Degeneracy in America. 
11 
Provinces. 
Elevation above 
Sea-Level. 
N umber of 
Goitrous. 
Buenos Ayres 
Feet. 
20 
38 
Santa F£ 
37 
18 
Entre Rios ... 
78 
69 
Corrientes 
77 
244 
Cordoba 
439 
135 
Santiago del Estero 
214 
47 
San Luis 
759 
58 
Mendoza 
805 
1712 
San Juan 
643 
64 
La Rioja 
505 
136 
Catamarca 
572 
222 
Tucuman 
465 
605 
Salta 
1202 
ii5° 
Jujuy 
1260 
535 
In the total of goitrous, 1701 are male and 3500 are female. 
Such are the data on which are based our views; but it is neces- 
sary to observe that goitre tends to disappear in several provinces, 
just as it maintains itself in others. 
At Tucuman, where formerly it was accompanied with cretinism, 
and where the population was obliged to abandon its position on the 
river Pztcblo Viejo to adopt that which it occupies to day, its diminu- 
tion is sensible. 
In Jujuy it disappears likewise, and this fact is due in great part 
to the epidemics of small-pox which raged from time to time among 
the Indians, and which killed a great number. Besides, among the 
causes which helped to obtain this good result, it is necessary to 
mention the great care that the people take of the cleanliness of 
their bodies, the diffusion of hygienic knowledge which forestalls dis- 
eases, and especially we have to name the crossing of the population 
with the strangers coming from different regions. 
The observations which would be needed to fix the time necessary 
for the development of goitre are wanting in our country. We know 
that some authorities of the Old World give it as fifteen days, and 
that a residence in the country subject to the endemic may produce 
it in a few weeks, especially in a new-comer. 
On the subject of its frequency, Bordier cites the following 
facts: At Clermont, in 1851, in 5635 soldiers, there have been 180 
goitrous; in 1874, at St. Etienne, in 1400 men, 280 contracted it ; at 
Colmar, in 1864, in 600 individuals, 107 were attacked ; and at Annecy 
in 682 persons, there were 128. 
We shall now offer some considerations on the state which gen- 
erally accompanies goitre,-cretinism; a veritable degeneration of 
the species, the last degree to which abut the consequences of the 
endemic. 12 
Albert S. Ashmead. 
Looked at from the etiological point of view, that degeneration has 
as principal factors climate, alimentation, diseases. We ought likewise 
to take into account the social causes, consanguineous marriages, the 
absence of crossing with individuals of other races, which crossing 
might produce renewal of type and the appearance of other aptitudes. 
All these causes are too well known and their effects too well 
determined for us to expose them in detail. We must remember that 
the climates act differently on the organism, impressing it more often 
in an unfavorable way, and predisposing it to disease. 
The climate of the northern part of the Argentine Republic is 
sometimes prejudicial to the stranger, and the chucho invades it. If 
we have some localities like Rosario de la Frontera and Puente del 
Inca, which are very favorable for the cure of rheumatism; Cosquin, 
Mendoza, and Lujan (Lujan, province of Buenos Ayres), special resi- 
dences of consumptives; on the other hand, the city of Buenos 
Ayres offers a field very vast for these affections, which attack a great 
number of inhabitants, not forgetting typhoid fever, diphtheria, and 
other diseases which are rooted there. 
We have said that goitre and cretinism are close ties, and that 
the second is a chronological state which obeys the acting causes, 
perpetuating their disastrous effects, transmitted by heredity, and of 
which the first of these diseases is the beginning. 
The relation is so evident that it has not escaped the common 
observation. 
The province of Mendoza, with its enormous quantity of 
goitrous, counts a rather considerable number of cretins, particularly 
in San Vicente, where the latter abound extraordinarily. 
If, in all the regions of the country where goitre reigns, one 
observes all its forms, it is the benign which is most common. 
It is absolutely impossible to offer exact information; the cen- 
sus of 1869 is the last which was taken, and it is easy to understand 
that to-day a fixed base to appreciate the fact is lacking. However, 
we have tried to offer a general view of the subject by jotting down 
the data we have been able to gather. 
As far as animals are concerned, we are able to say that at Tuc- 
uman, dogs and horses have been seen with hypertrophy of the 
thyroid body. 
In closing, we may declare that in numerous localities of the 
Argentine Republic goitre diminishes, and this can only be attributed 
to the crossing of the races. The infusion of a novel element into a 
population not yet mixed, must certainly produce a stronger type, 
more resistant and with favorable conditions, to struggle against the 
diseases. Racial Degeneracy in America. 
13 
In Bolivia goitre is very common. The eastern region of this 
country is the part most subject to the endemic, and especially be- 
tween the Rio Grande and Santa Cruz. In the south it is Tarija 
which is most attacked, to such a degree that in the high countries 
which occupy a considerable extent of the most populous zone, like 
Potosi, Sucre, La Paz, Cochabamba, and others, the word Tarijino is 
synonymous with goitrous. The same thing happens, as we have 
seen among us, with the goitrous of San Vicente (Mendoza), who are 
called Vicentenos. 
All the valleys are centres of production of the endemic. On 
the high planes or plateaux it is not known ; however, the inhabitants 
contract it when they descend into the lowlands. 
The Bolivians attribute the origin of the disease to a tree called 
Alizo, which grows on the banks of the rivers. Among the Indians 
and the lower classes it is a general belief that if, at the moment when 
they stoop to drink from these rivers the tree speaks to them, then 
they are doomed to become goitrous. 
It has been observed that in the city of Sucre, where formerly 
goitre did not exist, it is found to-day. Its appearance has coincided 
with a particular state of the conduits of the earth by which the flow- 
ing waters arrive; these conduits are dirty and contain a deposit of 
organic matter. 
In Peru, in the hollow of Vilcamayo, goitre is endemic, and cre- 
tinism accompanies it mostly. 
In Paraguay it is likewise frequent, especially at Villa Rica; at 
Asuncion one observes it among all social classes, but it is to be noted 
that probably these goitrous come from the country. 
In Mexico it exists in the villages of Santiago, Tuxtla, Huichapan, 
Pluejutla, Michoacan, Guerrero, and Sinaloa. 
Dr. W. Oliver Taylor, of Princeton (Ontario, Canada), writes 
me, " I have treated during the past eight years 217 cases of goitre. 
I find on examining my notes of these cases that some few have 
moved from this locality, a number have died, and a small proportion 
have only been under close observation for two or three months. The 
rest-181 cases-I have notes of, for a period varying from three or 
four months to seven years. Some of these cases I only see three 
or four times a year, the rest regularly at least monthly. The ages 
ranged from one case at 1 year to one case at 75 years, but fully 85 
per cent, have occurred between the ages of 13 and 48 years. The 
sex: 95 per cent, were females, the rest males. The duration of the 
disease before treatment, three to twelve months, in 70 per cent., and 
from one to twenty-five years in 30 per cent. 
" Quite a number of these cases came under my care during or 14 
Albert S. Ashmead. 
following pregnancy. The most intractable cases,-at or following 
the climacteric. Those cases of long duration were of the follicular 
or cystic form. 
"Thirteen of these cases had exophthalmus; two of these died 
of malignant disease,-one of cancer of the uterus and one cancer of 
the breast ; one died rather suddenly,-mitral valves badly inflamed. 
The other ten are in fair or poor health. All require more or less 
attention to the heart. 
"All the cases were white. 
" All were natives of Canada excepting thirty-seven. Of these 
thirty-seven, nine were born in the United States, one in Norway, two 
in Germany, and twenty-five in Great Britain. 
"The 217 cases occurred in 159 families. The largest number in 
one single family, three out of eleven daughters. 
"Quite 20 percent, suffer from severe headaches, usually lateral. 
Two-thirds are anemic. One lateral lobe is usually most prominent, 
but both generally involved. 
"In the 159 families are three dwarfs, three deaf-mutes, and 
three cases of myxedema. There are no cretins. 
"A few children born of goitrous parents are as bright and clear 
mentally as those of non-goitrous ; the majority have not the same 
mental calibre as those whose parents are free of goitre. 
" Still, it is only fair to say that two out of the three dwarfs had 
non-goitrous mothers at birth. Goitre developed in one mother sub- 
sequently, and in a sister of the other dwarf. One of the dwarfs is 
unusually bright mentally. The others are not so. 
"We have a rather level or gently rolling country,-a few rather 
steep hills,-but not a mountainous country. 
" This is not the ordinary experience of most observers, but the 
soil is highly impregnated with lime salts, and the drinking-water is 
decidedly hard. 
"This has been so important a factor in the treatment of the 
disease that for the past four years I have insisted on the exclusive 
use of distilled water. Without this I have found treatment very 
unsatisfactory, even in the mild cases. 
" Treatment.-Ninety-three cases have been treated by iodine 
alone ; nineteen cases by evacuation of contents and injection of iron ; 
four cases partially evacuated and injected with carbolic acid; thirty- 
one cases with injection of ergot or ergotine; twenty-five.cases with 
desiccated thyroids, and the rest were treated with local applications 
of hydrarg. ox. rub. or hydrarg. biniodidi. 
" Many of my cases have been improved by treatment rather than 
cured. Racial Degeneracy in America. 
15 
" I used the seton in five cases. My experience leads me to the 
conclusion that no one form of treatment is applicable to all cases of 
goitre. Good judgment is essential in dealing with these cases, and 
they must be selected. The seton gave me sleepless nights and 
anxious days,-fortunately no fatal results. 
"The doses of thyroids I used are larger than those of most 
physicians who have prescribed it. I used the tablets, not the powder. 
" Some thyroids easily undergo decomposition, and the relative 
strength of preparations of different houses are not the same; but I 
must say my patients have been able to take the large doses without 
difficulty, excepting in a few cases." 
Dr. J. P. West, of Bellaire, O., in the October number of the 
University Medical Magazine mentions eight rachitic dwarfs in 
the Ohio Valley, one, a mulatto, three, children of wealthy Scotch 
people.1 
Dr. George Dock, in an article entitled, "Goitre in Michigan," 
says that the disease is found in all parts of the latter State; it is 
most prevalent in the northern part, the two peninsulas, and the pro- 
portion of the lower peninsula is very considerable. Fifty-two re- 
porters give a total of 477 cases, not including the cases in the copper 
regions. In a large number of cases the goitre affects natives of 
Michigan, usually of the districts, but the disease is frequent also 
among foreigners. 
Dr. Munson, United States army, has investigated the question 
of goitre in certain American tribes. In 77,173 Indians residing on 
reservations, he found 1823 cases of goitre, or about 2.36 per cent. 
That would make for the whole Indian population on reservations 
about 1.23 per cent. He found it most prevalent in the Southern 
part of Montana. He believes that there is a racial predisposition 
to goitre in the Indians (to-day, I suppose he means) who live a 
rather unnatural life in the reservations, because it is almost unknown 
among the white settlers. The disease, according to Dr. Munson, is 
evidently caused by unsanitary surroundings, depressing constitu- 
tional conditions, and an improper because excessive nitrogenous diet. 
Professor Starr, of the University of Chicago (Department of 
Anthropology), has had the kindness of sending me this photograph 
of a full-blooded Cherokee goitrous Indian. I think I had better give 
Professor Starr's letter in extenso : " I send you with this a picture 
1 It is not uncommon, he says, to see a square-built individual below the average height, with a 
large, square head, prominent forehead, and a small face, with bent or bowed legs and arms, and 
probably flat feet. Examination of a number of such cases invariably shows large, rough joints, and 
peculiarly shaped chests. These are cases that it is natural to infer recovered, except the deformi- 
ties, without treatment. It is a natural inference that others died from the severity of the disease. . . . 
It is a still more natural inference that there were others yet who suffered to a lesser degree, and who 
recovered entirely and do not attract attention. 16 
Albert S. Ashin ead. 
of Shell George, a Cherokee Indian, of North Carolina. At the time 
the picture was taken he was about 33 years old. Full-blooded ; living 
' up Soko' not far from Cherokee, N. C. There are several other 
goitre cases up the Soko Valley. I find to my surprise that my notes 
of these cases appear to be mislaid. I can, however, I am quite sure, 
give you the facts. Two sisters have goitre: it is not as in Shell 
George's case, but more distributed, though very distinct, and on one 
side of the neck only. One of these sisters married, has two deaf- 
mute children, the only cases in that settlement. The other sister, 
married to a gentleman named Washington (full Cherokee both), has 
a boy who is certainly a cretin. He is some years of age ; has no use 
of his legs; has a large head quite out of proportion to his body; a 
stupid, expressionless face ; and is idiotic. 
"Two or three other cases occur in 'Birdtown.' These Indians 
that I saw are located in a group of neighboring settlements in Swain 
County, Cherokee, Soko, Big Cove, Birdtown. There were, perhaps, 
1200 in all the settlements. I think there are no cases of goitre, 
deaf-mutism, or cretinism in Cherokee or in Big Cove, though proba- 
bly two-thirds of the whole population is in those two settlements. 
But up Soko and at Birdtown it is recognized. The water-supplies 
of these two districts are independent of each other and of the other 
two. I cannot give cardinal points, but the settlements are located, 
as I remember them, about like this: 
Big Cove 
Cherokee 
, 3 miles 
3 miles 
Soko 
Birdtown 
Cherokee to Big Cove, io miles; Cherokee to Birdtown, 3 miles; 
Cherokee to Soko, 3 miles." 
The thyroid gland presides over the growth and development of 
the body. The excision of the same stops growth and stature, and 
generally prevents the change of voice at the age of puberty, and 
has also some influence on the mental faculties. Dr. McGraw, of 
Michigan, excised a thyroid gland in a goitrous boy, and the above A Cherokee Goitrous Indian. Racial Degeneracy in America. 
17 
effects distinctly appeared. On this case he writes to me as follows : 
" I excised the thyroid gland for general cystic degeneration in the 
person of George Metzger, aged 14, in 1881, two years before Kocher 
published his cases of cachexia strumipriva. The excision was total 
and was followed by myxedema. This continued until one year ago, 
when I began to treat it with Armour & Co.'s thyroid extract. The 
effect of the treatment was to cause a disappearance of the symptoms 
of myxedema, but also a profound debility, which necessitated its 
temporary discontinuance. He improved again, but in a short time 
came to me with paralysis of the larynx, which threatened serious 
consequences. From this he partially recovered and is now in pretty 
good health. I met him last riding a bicycle, short of breath, but 
professing himself well." 
According to Robinson, the deficiency of the thyroid secretion 
results finally in cretinism, but this is preceded by two other stages, 
congenital goitre,'atrophy of the gland in children, semicretinism; 
symptomatic degeneration is proportionate to the extent of the trouble 
in the thyroid gland. Extirpation of the thyroid causes cachexia 
(strumipriva), as happened in McGraw's case. 
Reverdin, of Geneva, points out that extirpation of the thyroid is 
followed by myxedema, and in children by arrest of development. 
Horsley, experimenting on monkeys, showed that the causes of 
the changes following removal of the thyroid, were the direct pro- 
ducts of imperfect nutrition. 
Dr. Brinton in his essay, "Variations in the Human Skeleton 
and their Causes," in discussing deficient nutrition, says, " Perhaps 
this is seen most palpably in the variations of stature within the same 
race and people. Dr. Collignon, who has made such admirable an- 
thropological studies of the population of France, finds the diminu- 
tion of stature in certain districts explainable by one word, la misere, 
the lack of proper and sufficient alimentation.1 Virchow, discussing 
the dwarfishness of the Lapps as compared with their cousins, the 
Finns, pronounces them Kummerformen, products of wretchedness. 
The shortest of the Bushmen are also the most miserable,-those 
living amid the barren sands of the Kalahari desert. It is not argued 
that misery alone is the cause of inferior stature, but it is one of the 
causes, and a potent one. 
Where we find it, we find also other variations from the same 
cause. The sternum of a Bushman is often not as much developed 
as that of a new-born infant with us ; true microcephaly is common 
in poorly-nourished communities, as are spina bifida, rickets, and other 
1 Archiv fiir Anthropologic, 1893. 18 
Albert S. Ashmead. 
diseases proceeding from osseous innutrition. There is nothing racial, 
still less pithecoid, in any of these traits. They flow from obvious 
and present conditions.1 
This is also true of those small, intercalated bones which develop 
or persist in various sutures of the cranium and face, the epactal bone, 
the ossa Wormiana, and the recently observed ossicula mentalia of 
Mies.2 The presence of these is to be understood as an evidence of 
deficient osteogenetic power, not its excess, as is sometimes stated. 
They are very generally associated with other signs of defective bone 
structure, as bifid sternum, perforation of the fossa olecrani, carious 
denture, and the like. They are most numerous in pathologic cases. 
Holden found over 100 Wormian bones in the skull of a hydrocephalic 
infant,3 and Hyrtl over 300 in that of a cretin.4 They are formed 
from multiple secondary centres of ossification because the primary 
centres were too feeble to supply the needs of the system. 
The epactal is really a large Wormian bone, arid the attempt to 
assign it an ethnic value under the name of os Incce, made by von 
Tschudi, fails upon examination. It is found, with equal or greater 
frequency, among the ancient Arizonians of the Salt River Valley? 
and Dr. Washington Matthews has inferred therefrom some closer 
relationship between these two peoples than that of race.5 But the 
simpler and more likely explanation is that in both instances we 
have a people subsisting upon a similar inadequate or at least non- 
osteoplastic alimentation, leading in each to similar semipathological 
variations from the norm. 
This is well illustrated in the remarkable frequency of patholog- 
ical exostoses in both peoples. Among the Saladoans they are found 
in about one-third of the subjects, a percentage nowhere equalled, so 
far as I know, except by the ancient skeletons from the vicinity of 
Lima, described by Virchow.6 
It is a singular instance of the misinterpretation of ethnic anat- 
1 Zeitschrift fiir Ethnologie, 1890, p. 441. Theeffectof long-continued limited nutrition may bring 
about diminution of stature, symmetrical and without pathological traits. Thus the extinct ele- 
phants of Malta became towards the close of the life of the species quite small. A small but vigorous 
breed of horses is found where food is scarce. In the Canary Islands the oxen, the horses, and the 
men all become smaller on the smaller islands (de Varigny). This explains the origin of the dwarf 
races, the Negritos of the Spice Islands, the Orang Pangang of the peninsula of Malacca, and the 
Pygmies of Central Africa. 
2 See L'Anthropologie, 1893, No. 4. 
3 Human Osteology, p. 103. 
4 Lehrbuch der Anatomie. p. 306. 
6 See Dr. Matthews's article, "The Inca Bone," in the American Anthropologist, October, 
1889 ; also his remarks on " Human Bones of the Hemenway Expedition" (Washington, 1893). The 
epactal or os Inca arises from a secondary centre of ossification which appears in the squamous 
portion of the occipital bone. Its genetic history is in all respects that of an or Wormianum. 
6 Ueber krankhaftveriinderte Knochen alter Peruaner, in Preussiche Akademie der Wissen- 
schaften, 1885. Racial Degeneracy in America. 
19 
omy when Professor Herve, of the School of Anthropology of Paris, 
says that the presence of these Wormian bones and the complexity of 
the cranial sutures are a measure of the rapidity of brain development, 
and consequently a criterion of the position of a race in the scale of 
humanity. It is merely an indication of osteogenetic vigor, or the 
reverse.1 
Another interesting fact comes in in this connection. Virchow 
has convincingly demonstrated that anomalies of the bony structure 
in man are constantly and markedly greater among uncivilized than 
among civilized peoples, and consequently greater among ancient 
races than among those now living.2 This is in accordance with what 
holds good of the lower animals, for Bateson has shown by an exten- 
sive collation of evidence that Darwin was quite in error in main- 
taining that variation is greater in domesticated than in wild animals.3 
In man its increase in the savage state evidently depends upon fluc- 
tuations in the food-supply and frequent changes and excessive stress 
of mechanical function as the prime factors. These brief suggestions 
will, I hope, be sufficient to place before you clearly another and, I 
believe, a juster method of studying the ethnic anatomy of the bones 
than you will find in ordinary treatises. The polygenists and the 
reversionists seem opposed to admitting the action of familiar natural 
causes. Because a human variation is pithecoid, they illogically jump 
to the conclusion that it is pithecogenetic. Instead of looking on it 
as the natural result of an existing tendency, they claim it is a return 
to some primitive type. In fine, instead of accepting the nearest and 
plainest explanation of an observed fact, they put forward one in 
itself absolutely inexplicable and carrying with it a tissue of hypoth- 
eses, not one of which is more than a surmise. 
Coming back to the question of goitre in certain American races 
and to the dwarfing so often seen in goitrous families, we find that 
goitre and dwarfing are most frequent in those races which present 
the greatest anomalies in bone development, the South American 
and negro mixed races, where we find such peculiarities as Wormian 
and Inca bones ; these, if we believe Brinton, are due to insufficient 
nutrition and degeneracy of the race. 
Haliburton, in his study of the survival of dwarf races in the 
New World, speaks of dwarfs that invaded British Honduras in 1882; 
he says, that the famous Panama hats are made by these dwarfs (not 
in Panama, but on the Garrion River, in British Honduras). He 
gives their height as four to four and a half feet (any individual, 
1 See Hovelacque and Herv£, Precis d'Anthropologie, p. 59. 
2 See Zeitschrift fur Ethnologic, 1891, pp, 54, 56, etc. 
3 Wm. Bateson, Materials for the Study of Variation, p. 572. 20 
Albert S. Ashmead. 
whose size is not over five feet three inches is dwarf). These Maya- 
gans (as he calls them) come from the Maya country in Yucatan. 
He mentions another dwarf tribe, Lacoutou, who live on the dividing 
line between Guatemala, Yucatan, and British Honduras. Like other 
dwarf races they have a prominent abdomen. Mrs. Le Piongeon, in 
her " Up and Down Yucatan," speaks of a very small dwarf woman, 
wearing a large hat (Haliburton writes me that the dwarfs of old 
were noted for wearing hats and caps, in some cases large), who 
was captured by wood-cutters on the frontier of British Honduras. 
There is a place called the " City of the Dwarf," near the Andes. 
(See photograph, showing a Honduras dwarf with a large hat and a 
pug nose, like that of a Pyreneean dwarf, "like a little ball," it is 
called by Professor Moragla.) 
It 'is believed by Cunningham Graham that there are dwarf 
tribes living on islands at the head waters of the La Plata River. 
Mr. Haliburton specially mentions what he calls "dwarf klichts;" 
defects of articulation to which are due sounds impossible to repre- 
sent by writing. I think that these must be due to a flapping of the 
vocal cords, or the cartilages of the larynx, due to some anomalous 
condition of thyroid gland. The sound thus produced might be rep- 
resented, according to Haliburton, by psecht, pecht: this sound is 
called by the dwarfs, " word eating." Mr. Haliburton has explored 
dwarfdom in the whole world,-that is, among the Klamaths, in the 
Cascade Range, in Spain, Morocco, among the Bushmen, in the Pyr- 
enees, in South America, Mexico, and among the diseased of the 
Scottish Picts. He it was who discovered the dwarf races of North 
Africa, in Sahara, and the Atlas (as Sweinfurth 1 did those of Central 
Africa), in a paper entitled, " Dwarfs and Dwarf Worship," which was 
read before the Ninth Congress of Orientalists, 1881. He thinks 
that cretinism in the Pyrenees and the Alps is racial and not a dis- 
ease. " It is a symptom of decadence in a moribund dwarf-race, who 
in the recesses of the mountains are slowly going through the 
process of dying out." 
Professor Starr writes, " I have seen no little people in Mexico 
that begin to be as small as the African pygmies. I am told that in 
the Barranca (Gorge), near Guadalapaia, are ' cretin dwarfs' (plainly 
diseased). I believe that my informant stated that the same thing 
was true in other barrancas. So far as African dwarf populations are 
concerned, they are usually described as lively, active, energetic, brave 
to a degree in hunting. Would the character thus described be likely 
to accompany goitre-stricken people on their way to cretinism ?" 
1 Sweinfurth, Heart of Africa. A Honduras Dwarf. Racial Degeneracy in America. 
21 
I am told by Haliburton that the manager of the Liliputian Opera 
Company got several very small dwarfs in the Black Forest. "Their 
relations were generally of ordinary stature. These survivals are like 
the numerous ones that Professor Sergi found in Sicily and parts of 
Italy. The influence of atavism accounts for all the cases of dwarfs 
that are not the result of rickets. ... I advise you," says Hali- 
burton, "to look over the files of 'Nature' (London, 1893-95), and 
you will see an account of the dwarfs of a district in Madras-described 
by Colonel Fraser, R.A. The dwarfs are all males, who when six to 
eight years of age stop growing. They marry ordinary sized women, 
and beget children,-the daughters healthy and like the mothers, the 
sons dwarfs and so feeble that the larger people have to support them. 
It is a singular instance of even a half-breed strain dying out. One 
would suppose that an infusion of healthy blood from a larger race 
would counteract the tendency of dwarf races, under uncongenial 
surroundings and using poor food, to degenerate and die out. . . . 
You will be much interested at the wonderful facts that have come to 
light as to dwarf races, all over the world, and their being substan- 
tially one race." 
Brinton is of quite different opinion. He denies decidedly the 
existence of dwarf races. In his review of Quatrefages, "pygmies," 
he says, " Probably any people would become dwarfs under certain 
conditions, and the trait is therefore not a racial one." 
At the meeting of the American Association, in Brooklyn, in 
1894, the same author affirms "that he knows of no existing dwarf 
races, and did not believe in their existence." 
Brinton also says (Review of American subjects at the German 
Anthropological Association, Innspruck, 1894), " Dr. Virchow, in 
discussing dwarf races, spoke of some very small (nanocephalic) 
skulls from Southern Venezuela and Colombia, but did not assert that 
they indicated a pygmy tribe there resident, as his argument rather 
was that the cerebral capacity does not necessarily prove that the 
person who carried the skull was of extremely low stature. In fact, 
up to the present time, though individual dwarfs are known to have 
been artificially cultivated in Mexico for the amusement of the 
nobles (!), no dwarf tribe has yet been discovered."