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Utah goiter survey
UTAH GOITER SURVEY* INCLUDING
EXAMINATION RALPH
RICHARDS,
OF 110,000 CHILDREN M.D.,
F.A.C.S.
SALT LAKE CITY, UTAH
F
Four degrees of enlargement were recorded: (I) “Th e question mark or prewhere the neck couId goitrous group,” not be pronounced negative and yet the degree of enIargement was so sIight that one might hesitate to say the individua1 had goiter; (2) “sIight,” any enlargement up to I in.; 13) “moderate,” an;; enlargement from I to 2 in.; (4) “great, any enIargement ov.er 2 in. The survey showed the average goiter incidence to be 32 per cent. among the boys and 54.5 per cent among the girls. A dozen localities showed less than IO per cent goiter and in two or three of these communities almost every case was an imported one. In contrast to these places there were sections where every boy and gir1 in school showed some degree of enIargement. Again, in one district, there was a variation from 6 per cent in one schoo1 to IOO per cent in another near by. But these schooIs were situated differentIS from a geoIogica1 standpoint. Furthermore, no racia1 immunity to thyroid enIargement was found. Representatives of practicaIIy every race that immigrates to America were examined, in one school thirtv-six different nationalities. Interest was centered on the Indians because of an opportunity afforded to examine a considerabIe number of these peopIe living, as far as water and food supply are concerned, under conditions simiIar to the IocaI whites. Indians, as a rule, were found to be slightly Iess susceptible to goiter. It was noted that male Indians had a higher incidence of thyroid enIargement than females. This pecuIiarit,vwas found to be true of the Indians whether on reservations or in the pubIic schooIs. SampIes of drinking water from many sections of the state were examined bv Dr. J. F. McCIendon of the University ol
OR many years the Utah State Board of HeaIth has been interested in the goiter problem. It attempted Iimited surveys as early. as 1910, but it was not unti1 192.4 that it was possible to make a state-wide survey, which was deemed advisable before undertaking any prophyIactic measures. Dr. James Wallace was placed at the head of the work in 1924 and the examinations were completed in 1925. SchooI children to the number of 90,000 were examined by Dr. WaIIace and the remaining 20,000 under his supervision. A preIiminary articIe, covering the first 69,000 chiIdren, was pubIished. l The compIete report of the Utah investigation is quite Iengthy and cannot be given in detail here. At best, we can briefly discuss the genera1 considerations invoIved. Utah contains 84,990 square miIes, an area one and one-haIf times that of Michigan. The goiter survey is the Iargest numericaIIy and the most extensive geographicaIIy of any in the United States. The tota number of schoo1 chiIdren examined was I 10,086, 54,935 boys and 55,15 I girls, representing approximateIy 25 per cent of the tota popuIation of the state. The examination was conducted by inspection of each pupi in a good Iight. The thyroid gIand was paIpated and again palpated as the pupi swallowed. In these examinations, the cooperation of the Iocal doctors was sought and in some of the Iarger centers many of the examinations were made under supervision. An attempt was made to standardize the diagnosis as much as possibIe in order that the findings of the different examiners might be on a uniform basis and therefore comparabIe.
*Read
at thr
Annual
&Ieeting
of the American
Associntion 44
for the Study of Goiter,
Dcnvvr,
June
18-20,
1928.
XIinncsota. His results indicate a less dcflnite inverse relationship between iodine in the drinking water and the occurrence of goiter than figures from otfler parts of the cvuntry. LVith the exception of the 1lilt’orcf sample they all show-ed marked iocfine deficiency, when judged b\- the stancfarcf that proper drinking water suppf~ r-quir-ed 1;\-e parts per billion of iodine. A sample of water from Great Saft Lake, the principle source oT the table salt used in Utah, Fief&d severit~~ parts 0T iodine per billion of water. A11 of this iodine is lost in the process of manufacturing table salt: on account of the method used in precipitation. The following striking fact \vas noted in Kaysviffe, a town on the shore of Great Salt Lake: FormerI\- the citizens produced their table salt focaffy without of evaporation f1!. a process relining. The incidence of goiter at that time xvas veq- low-. Later, \vhen the focal method of production was abandoned and the commercial product substituted, there \V:IS a large noticeable increase of goiter. A fike increase in seteraf localities has foffowed the instaffation of improved water supplies from mountain sources repkcing foc:~f IveIls.
Details v,.ere taken regarding the length of residence in the town of the adults examined, and the comparative t’rcedom from thyroid enlargement among those who had fix-cd in the region for some time. The water supply of this focalit~ is from weffs 200 to $00 feet deep. The details gathered further shoved that in a goitrous area like Utah thel-e is ver)’ little less enlargement of the t h>-r-oid gland among the adult population than a1nong the school population and that the number of cases that are only “temporary-” in cflifdren is very smaff and that of a11 those \vho develop enfargements when chifdrcn, not more than about 20 per cent of these among the males and IO enlargements, per cent among the females, disappear spontaneously. PROPHYLAXIS
A large amount of proph! lactic work has been done in the schoofs. The State Board of Health has urged the use of chocolate tablets containing IO mg. of iodine, one tablet to be taken once a week for the fort?: weeks of the school J-ear. Through the cooperation of the superintendents and teachers, in one year, more than I,ZOO,OOO of these tahfets were administered to the .-\DULT SUl<\‘EYS pupils. Alany more have been administered which ha1.e not been reported to the State in orcfer to determine approximateI)in Roard of Heafth. Besides this man>. parents, \f.hat percentage of children thyroid enfollowing the idea1 methocf, ha\-e taken ph\-sioIogica1 and largement was “purely their chiftfren to their o\vn physicians t’or woufcf naturalf~- recede,” it \vas decided prophylaxis or treatment. to make a survev of adults and see how In the foregoing summary of the Utah the!- caompared &th the school children. goiter sur\.ey it has been pornted out that Six to\vns were selected, four in the south, the thyroid gland enlargement in children, one about the center of popufation and among a11 races of people, may be t;)und in one in the north. These towns lvere sura11 sections of the state, with marked \-e>ecf fly a house to house visitation, in local \.nrintions of incidence and that the order that e\.er?- adult \voufd be included; occurrence of goiter among ;itlufts is not ancf onI\- half a dozen persons refused much less than among children. It has also examination. been sholvn that there is a lack of cv)rrefaFarmington, Oak Of these focafities, tion between the percentage of icodine in City-, Pro\?dence and Cedar City were the samples of drinking water t’rom differchosen because a high percentage of goiter ent localities and in the pre\~aknce ot hat1 been found among the schoo1 popufngoiter in these same communities. tion; Delta and Mifford, holvever, kvert There is another interesting :Ispect of chosen because the incidence WAS low-. Tficse t\\o to\vns are comparati\ efy nehv. the Utah problem xvhich \vas not. co\,ered in
46
American
Journnl
of Surgery
Richards-Utah
any detai1 in the State survey. It has to do with the geoIogica1 features of the intermountain region, which differ from every other section of the United States. PracticaIIy the whole of America is drained by water sheds which discharge their burdens into streams which flow into the ocean. In the arid region between the Uinta mountains on the east and the Sierra Nevada mountains on the west invoIving the western haIf of Utah, smaII contiguous sections of Wyoming, Idaho and Oregon, nearIy a11 of Nevada, a Iarge part of CaIifornia an d southern and eastern extending into Mexico, is a Iand area caIIed the Great Basin which has no outlet to the ocean. AI1 the streams of saline lakes or this region fIow into evaporate. In the Quaternary geoIogica1 period, Canada and the northern half of the United States were covered by four miIIion square miIes of ice, during the so-caIIed Ice Period. This sheet did not co\-er the section west of the Rocky Mountains. At that time the precipitation was much more abundant than at present. There was more water falling than was evaporating and it gathered in the various depressions in the bottom of the Great Basin, forming numerous Iakes of which we stili h ave evrdence. . In Utah this water accumuIated to the depth of a thousand feet and formed a lake called Lake BonneviIIe, the size of Lake Michigan, at which point it stayed for a long period, etching into the mountain sides a Iine of wave-wrought cliffs and depositing under the water edge the disintegrated rock in the form of a IeveI shelf of sand and gravel. That this IeveI was maintained for a long time is evidenced bs- the fact that this underwater sheIf had time to build itseIf severa hundred yards wide in places. This IeveI known as’ the Bonneville Shore Lme persists to the present dav and can be traced aIong the mountiin sides for hundreds of miles. The outlet of this Iake was at the north an d was through a rather Ioose formation waters cut through which the discharging
Goiter
Survev
JULY,
1<>2r)
a channel, four hundred feet deep, to be halted by a hard Iimestone Iedge which heId the waters at this stage Iong enough to buiId another deliniteIy defined shoreIine which is caIIed the Provo Shore Line. At this time precipitation diminished to the point where it was insufhcicnt to keep the Iake fuI1. Then the water receded rapidI) and Ieft two remnants of Lake BonnevilIe, Great Salt Lake on the north and Sevier Lake on the south. At the point where the Iake faiied to empty itseIf the character of the water began to change; the soIubIe mineraIs from its drainage area were brought down to the Iake and remained in soIution. Through the ages those mineraIs became more concentrated as there were more coming in each year and the lake water was getting smaIIer in amount. This process did not Ieave its mark unti1 the dessication and concentration reached the Iower IeveIs of the Iake bottom and then the chemicals were deposited. This process is stiII going on. Great SaIt Lake, during the Iast sevent)-five years, has varied as much as 9 feet in its average depth, because of the irreguIarity of seasona precipitation and evaporation. At its Iow point it has left great stretches of richIy mineralized deposits on the shaIIow at the edge of the lake. The waters of the Iake itseIf contain 13 to 18 per cent sodium chIoride, according to the season; 2 per cent phosphates: numerous other chemicals in smaIIer amounts and seventy parts per biIIion of iodine, a higher percentage than any of the ocean anaIyses. Sevier Lake, the southern remnant of Lake Bonneville, is going through the same fluctuations as Great SaIt Lake and has Ieft, during its desiccation and shrinkage, a flat desert country to the north richly impregnated with mineraIs which in agricuIture are designated under the generic term “aIkaIi” which indicates a11 those chemicaIs which in sufficient concentration prevent the growth of vegetation. In order that we may study the possibIe relationship of the Lake Bonneville phenomenon to the distribution of goiter. x1-e
XI.\\
?,FKIES
VOL.VII,
No.
I
Richards-Utah
may gIance at a map of the State of Utah and see that the mountainous regions on and ab0L.e the BonneviIle shore lines show :I high percentage of goiter, bvhile the towns in the desert country, representing the Io\\.est part of the oId Iake bottom, show a lo\\- percentage. A map of blillard county illustrates these sharpI\contrasting conditions within a smal1 llrea; therefore we shall use this county for illustration because it has been twice surveyed in detail, by the State Board of HeaIth-in 1924 and by the writer in 1923. On the east side of Millard County, situated on the level bench Iand above the Pro\.0 shore Iine, are six olcl mountain towns, Leamington, Oak City, Holden, Fillmore, AIeadow ancl Kanosh, which she\\, an a\-erage of 73 per cent goiter among the school children. The drinking rvater supply- of this group is derived from the adjacent mountains and is Iow in iodine. Oak City had 0.017 parts of iodine per billion. Her goiter percentage in 1923 \vas 90 and in 1924, after a l-ear of prophylazis, it was 82. The people of this district live IargeIy on the IocaIIy grown produce, cultivated on the soil washed do\vn from the same mountains mhich furnish the drinking and irrigation water. Here the problem seems to be comparati\.el,v simple because nnaI\:ses of the drinking \vater give the clue to the total iodine as represented in drinking lvater, irrigation lvater, soil and food. T\tenty to forty miIes away, on the lake bottom desert is another group of old and Desert, tcmm, HinckIeg, Oasis kvhich ha\-e an average of about IO per Near them is the town of cent goiter. Delta which is comparntivel~~ new and oft‘crs an opportunity to contrast the old inhabitants with the new, to show what effect desert dwelling has upon those recruit cd largely from the goiter districts. The school figures of Delta showed 22 per cent th>-roid enlargement. A residence duration sur\-eJ- of the pupils showed that children living there fi\ye years or Ionger hntl only I I per cent goiter.
Goiter
Sur\-e)
AmericanJournal01Su,::t rv
47
The ground waters of this area have been thoroughly studied by the United States Geologica Survey. The drinking water is obtained from artesian weIls which tap severa water bearing strata at different depths. These strata are suppIied from a catchment area above the Provo shore line twenty to forty miles away. This accounts for the fact that the drinking water analysis from two artesian IeveIs showed .029 and .08 parts per billion of iodine. It is immediately apparent that the amount of iodine in the drinking water does not expIain the fact that there is a small amount of goiter on the desert and a Iarge amount in the nearb). mountains. The irrigation lvater in the desert is entirely different from the drinking water. It comes from the Sexier River which travels 300 miIes through all sorts of formations before being spread upon the land. In looking for another source of iodine a chemical investigation wil1 be pursued until the r-ale of irrigation water is understood. S&l is the next possible factor influencing goiter. Fifteen hundred soil :samples from this section have been analyzed in detail, with the exception of iodine determination. The IocaI station of the Department of Agriculture is now prepared to investigate iodine. This promises to be an extremely interesting study because of the high alkali content of the soils. Food anaIyses ha\re not been made with the exception of a few specimens of wheat from Oak City examined by Forbes and his associates of the Ohio Experiment Station. A trace of iodine was found in I sample. This brief discussion of the Lake Bonne\,iIIe reIationship to goiter is in the nature of a preliminaqreport onI?. There seems to .be suflicient evidence to justify the hypothesis that: The soi and irrigation water as contributors to the food chemistry ma\? be the sources of sufficient ndditional ‘iodine to account for the smaI1 amount of goiter in the desert country-. At the completion of the irrigation ancl soil analgsis a ful1 report will be made.
EXAMINATION RALPH
RICHARDS,
OF 110,000 CHILDREN M.D.,
F.A.C.S.
SALT LAKE CITY, UTAH
F
Four degrees of enlargement were recorded: (I) “Th e question mark or prewhere the neck couId goitrous group,” not be pronounced negative and yet the degree of enIargement was so sIight that one might hesitate to say the individua1 had goiter; (2) “sIight,” any enlargement up to I in.; 13) “moderate,” an;; enlargement from I to 2 in.; (4) “great, any enIargement ov.er 2 in. The survey showed the average goiter incidence to be 32 per cent. among the boys and 54.5 per cent among the girls. A dozen localities showed less than IO per cent goiter and in two or three of these communities almost every case was an imported one. In contrast to these places there were sections where every boy and gir1 in school showed some degree of enIargement. Again, in one district, there was a variation from 6 per cent in one schoo1 to IOO per cent in another near by. But these schooIs were situated differentIS from a geoIogica1 standpoint. Furthermore, no racia1 immunity to thyroid enIargement was found. Representatives of practicaIIy every race that immigrates to America were examined, in one school thirtv-six different nationalities. Interest was centered on the Indians because of an opportunity afforded to examine a considerabIe number of these peopIe living, as far as water and food supply are concerned, under conditions simiIar to the IocaI whites. Indians, as a rule, were found to be slightly Iess susceptible to goiter. It was noted that male Indians had a higher incidence of thyroid enIargement than females. This pecuIiarit,vwas found to be true of the Indians whether on reservations or in the pubIic schooIs. SampIes of drinking water from many sections of the state were examined bv Dr. J. F. McCIendon of the University ol
OR many years the Utah State Board of HeaIth has been interested in the goiter problem. It attempted Iimited surveys as early. as 1910, but it was not unti1 192.4 that it was possible to make a state-wide survey, which was deemed advisable before undertaking any prophyIactic measures. Dr. James Wallace was placed at the head of the work in 1924 and the examinations were completed in 1925. SchooI children to the number of 90,000 were examined by Dr. WaIIace and the remaining 20,000 under his supervision. A preIiminary articIe, covering the first 69,000 chiIdren, was pubIished. l The compIete report of the Utah investigation is quite Iengthy and cannot be given in detail here. At best, we can briefly discuss the genera1 considerations invoIved. Utah contains 84,990 square miIes, an area one and one-haIf times that of Michigan. The goiter survey is the Iargest numericaIIy and the most extensive geographicaIIy of any in the United States. The tota number of schoo1 chiIdren examined was I 10,086, 54,935 boys and 55,15 I girls, representing approximateIy 25 per cent of the tota popuIation of the state. The examination was conducted by inspection of each pupi in a good Iight. The thyroid gIand was paIpated and again palpated as the pupi swallowed. In these examinations, the cooperation of the Iocal doctors was sought and in some of the Iarger centers many of the examinations were made under supervision. An attempt was made to standardize the diagnosis as much as possibIe in order that the findings of the different examiners might be on a uniform basis and therefore comparabIe.
*Read
at thr
Annual
&Ieeting
of the American
Associntion 44
for the Study of Goiter,
Dcnvvr,
June
18-20,
1928.
XIinncsota. His results indicate a less dcflnite inverse relationship between iodine in the drinking water and the occurrence of goiter than figures from otfler parts of the cvuntry. LVith the exception of the 1lilt’orcf sample they all show-ed marked iocfine deficiency, when judged b\- the stancfarcf that proper drinking water suppf~ r-quir-ed 1;\-e parts per billion of iodine. A sample of water from Great Saft Lake, the principle source oT the table salt used in Utah, Fief&d severit~~ parts 0T iodine per billion of water. A11 of this iodine is lost in the process of manufacturing table salt: on account of the method used in precipitation. The following striking fact \vas noted in Kaysviffe, a town on the shore of Great Salt Lake: FormerI\- the citizens produced their table salt focaffy without of evaporation f1!. a process relining. The incidence of goiter at that time xvas veq- low-. Later, \vhen the focal method of production was abandoned and the commercial product substituted, there \V:IS a large noticeable increase of goiter. A fike increase in seteraf localities has foffowed the instaffation of improved water supplies from mountain sources repkcing foc:~f IveIls.
Details v,.ere taken regarding the length of residence in the town of the adults examined, and the comparative t’rcedom from thyroid enlargement among those who had fix-cd in the region for some time. The water supply of this focalit~ is from weffs 200 to $00 feet deep. The details gathered further shoved that in a goitrous area like Utah thel-e is ver)’ little less enlargement of the t h>-r-oid gland among the adult population than a1nong the school population and that the number of cases that are only “temporary-” in cflifdren is very smaff and that of a11 those \vho develop enfargements when chifdrcn, not more than about 20 per cent of these among the males and IO enlargements, per cent among the females, disappear spontaneously. PROPHYLAXIS
A large amount of proph! lactic work has been done in the schoofs. The State Board of Health has urged the use of chocolate tablets containing IO mg. of iodine, one tablet to be taken once a week for the fort?: weeks of the school J-ear. Through the cooperation of the superintendents and teachers, in one year, more than I,ZOO,OOO of these tahfets were administered to the .-\DULT SUl<\‘EYS pupils. Alany more have been administered which ha1.e not been reported to the State in orcfer to determine approximateI)in Roard of Heafth. Besides this man>. parents, \f.hat percentage of children thyroid enfollowing the idea1 methocf, ha\-e taken ph\-sioIogica1 and largement was “purely their chiftfren to their o\vn physicians t’or woufcf naturalf~- recede,” it \vas decided prophylaxis or treatment. to make a survev of adults and see how In the foregoing summary of the Utah the!- caompared &th the school children. goiter sur\.ey it has been pornted out that Six to\vns were selected, four in the south, the thyroid gland enlargement in children, one about the center of popufation and among a11 races of people, may be t;)und in one in the north. These towns lvere sura11 sections of the state, with marked \-e>ecf fly a house to house visitation, in local \.nrintions of incidence and that the order that e\.er?- adult \voufd be included; occurrence of goiter among ;itlufts is not ancf onI\- half a dozen persons refused much less than among children. It has also examination. been sholvn that there is a lack of cv)rrefaFarmington, Oak Of these focafities, tion between the percentage of icodine in City-, Pro\?dence and Cedar City were the samples of drinking water t’rom differchosen because a high percentage of goiter ent localities and in the pre\~aknce ot hat1 been found among the schoo1 popufngoiter in these same communities. tion; Delta and Mifford, holvever, kvert There is another interesting :Ispect of chosen because the incidence WAS low-. Tficse t\\o to\vns are comparati\ efy nehv. the Utah problem xvhich \vas not. co\,ered in
46
American
Journnl
of Surgery
Richards-Utah
any detai1 in the State survey. It has to do with the geoIogica1 features of the intermountain region, which differ from every other section of the United States. PracticaIIy the whole of America is drained by water sheds which discharge their burdens into streams which flow into the ocean. In the arid region between the Uinta mountains on the east and the Sierra Nevada mountains on the west invoIving the western haIf of Utah, smaII contiguous sections of Wyoming, Idaho and Oregon, nearIy a11 of Nevada, a Iarge part of CaIifornia an d southern and eastern extending into Mexico, is a Iand area caIIed the Great Basin which has no outlet to the ocean. AI1 the streams of saline lakes or this region fIow into evaporate. In the Quaternary geoIogica1 period, Canada and the northern half of the United States were covered by four miIIion square miIes of ice, during the so-caIIed Ice Period. This sheet did not co\-er the section west of the Rocky Mountains. At that time the precipitation was much more abundant than at present. There was more water falling than was evaporating and it gathered in the various depressions in the bottom of the Great Basin, forming numerous Iakes of which we stili h ave evrdence. . In Utah this water accumuIated to the depth of a thousand feet and formed a lake called Lake BonneviIIe, the size of Lake Michigan, at which point it stayed for a long period, etching into the mountain sides a Iine of wave-wrought cliffs and depositing under the water edge the disintegrated rock in the form of a IeveI shelf of sand and gravel. That this IeveI was maintained for a long time is evidenced bs- the fact that this underwater sheIf had time to build itseIf severa hundred yards wide in places. This IeveI known as’ the Bonneville Shore Lme persists to the present dav and can be traced aIong the mountiin sides for hundreds of miles. The outlet of this Iake was at the north an d was through a rather Ioose formation waters cut through which the discharging
Goiter
Survev
JULY,
1<>2r)
a channel, four hundred feet deep, to be halted by a hard Iimestone Iedge which heId the waters at this stage Iong enough to buiId another deliniteIy defined shoreIine which is caIIed the Provo Shore Line. At this time precipitation diminished to the point where it was insufhcicnt to keep the Iake fuI1. Then the water receded rapidI) and Ieft two remnants of Lake BonnevilIe, Great Salt Lake on the north and Sevier Lake on the south. At the point where the Iake faiied to empty itseIf the character of the water began to change; the soIubIe mineraIs from its drainage area were brought down to the Iake and remained in soIution. Through the ages those mineraIs became more concentrated as there were more coming in each year and the lake water was getting smaIIer in amount. This process did not Ieave its mark unti1 the dessication and concentration reached the Iower IeveIs of the Iake bottom and then the chemicals were deposited. This process is stiII going on. Great SaIt Lake, during the Iast sevent)-five years, has varied as much as 9 feet in its average depth, because of the irreguIarity of seasona precipitation and evaporation. At its Iow point it has left great stretches of richIy mineralized deposits on the shaIIow at the edge of the lake. The waters of the Iake itseIf contain 13 to 18 per cent sodium chIoride, according to the season; 2 per cent phosphates: numerous other chemicals in smaIIer amounts and seventy parts per biIIion of iodine, a higher percentage than any of the ocean anaIyses. Sevier Lake, the southern remnant of Lake Bonneville, is going through the same fluctuations as Great SaIt Lake and has Ieft, during its desiccation and shrinkage, a flat desert country to the north richly impregnated with mineraIs which in agricuIture are designated under the generic term “aIkaIi” which indicates a11 those chemicaIs which in sufficient concentration prevent the growth of vegetation. In order that we may study the possibIe relationship of the Lake Bonneville phenomenon to the distribution of goiter. x1-e
XI.\\
?,FKIES
VOL.VII,
No.
I
Richards-Utah
may gIance at a map of the State of Utah and see that the mountainous regions on and ab0L.e the BonneviIle shore lines show :I high percentage of goiter, bvhile the towns in the desert country, representing the Io\\.est part of the oId Iake bottom, show a lo\\- percentage. A map of blillard county illustrates these sharpI\contrasting conditions within a smal1 llrea; therefore we shall use this county for illustration because it has been twice surveyed in detail, by the State Board of HeaIth-in 1924 and by the writer in 1923. On the east side of Millard County, situated on the level bench Iand above the Pro\.0 shore Iine, are six olcl mountain towns, Leamington, Oak City, Holden, Fillmore, AIeadow ancl Kanosh, which she\\, an a\-erage of 73 per cent goiter among the school children. The drinking rvater supply- of this group is derived from the adjacent mountains and is Iow in iodine. Oak City had 0.017 parts of iodine per billion. Her goiter percentage in 1923 \vas 90 and in 1924, after a l-ear of prophylazis, it was 82. The people of this district live IargeIy on the IocaIIy grown produce, cultivated on the soil washed do\vn from the same mountains mhich furnish the drinking and irrigation water. Here the problem seems to be comparati\.el,v simple because nnaI\:ses of the drinking \vater give the clue to the total iodine as represented in drinking lvater, irrigation lvater, soil and food. T\tenty to forty miIes away, on the lake bottom desert is another group of old and Desert, tcmm, HinckIeg, Oasis kvhich ha\-e an average of about IO per Near them is the town of cent goiter. Delta which is comparntivel~~ new and oft‘crs an opportunity to contrast the old inhabitants with the new, to show what effect desert dwelling has upon those recruit cd largely from the goiter districts. The school figures of Delta showed 22 per cent th>-roid enlargement. A residence duration sur\-eJ- of the pupils showed that children living there fi\ye years or Ionger hntl only I I per cent goiter.
Goiter
Sur\-e)
AmericanJournal01Su,::t rv
47
The ground waters of this area have been thoroughly studied by the United States Geologica Survey. The drinking water is obtained from artesian weIls which tap severa water bearing strata at different depths. These strata are suppIied from a catchment area above the Provo shore line twenty to forty miles away. This accounts for the fact that the drinking water analysis from two artesian IeveIs showed .029 and .08 parts per billion of iodine. It is immediately apparent that the amount of iodine in the drinking water does not expIain the fact that there is a small amount of goiter on the desert and a Iarge amount in the nearb). mountains. The irrigation lvater in the desert is entirely different from the drinking water. It comes from the Sexier River which travels 300 miIes through all sorts of formations before being spread upon the land. In looking for another source of iodine a chemical investigation wil1 be pursued until the r-ale of irrigation water is understood. S&l is the next possible factor influencing goiter. Fifteen hundred soil :samples from this section have been analyzed in detail, with the exception of iodine determination. The IocaI station of the Department of Agriculture is now prepared to investigate iodine. This promises to be an extremely interesting study because of the high alkali content of the soils. Food anaIyses ha\re not been made with the exception of a few specimens of wheat from Oak City examined by Forbes and his associates of the Ohio Experiment Station. A trace of iodine was found in I sample. This brief discussion of the Lake Bonne\,iIIe reIationship to goiter is in the nature of a preliminaqreport onI?. There seems to .be suflicient evidence to justify the hypothesis that: The soi and irrigation water as contributors to the food chemistry ma\? be the sources of sufficient ndditional ‘iodine to account for the smaI1 amount of goiter in the desert country-. At the completion of the irrigation ancl soil analgsis a ful1 report will be made.