Dr. James Johnson remarks "We find in the Valais (one of the Swiss cantons), and in the lower gorges or ravines that open on its sides, both Cretinism and Bronchocele in the most intense degrees. As we ascend the neighbouring mountains, Cretinism disappears, and Goitre only is observed. And when we get to a certain altitude, both maladies vanish.

More recent and extensive observation of the localities infested by Goitre have rendered it improbable that the disease derives its origin from any deleterious properties in the air. Certainly it is not owing to anything that is common to all mountainous countries. Some parts of Switzerland are free from it. So are the Highlands of Scotland. It is met with also in flat situations in Norfolk, and also in Cambridgeshire. In one village in particular, about five miles from Cambridge, it is extremely common. Humboldt tells us that in South America Bronchocele is met with, both in the upper and lower course of the Magdalen River; and in the flat, high country of Bogota, 6000 feet above the bed of the stream. The first of these regions is a thick forest; while the second and third present a soil destitute of vegetation. The first and third are exceedingly damp; the second peculiarly dry. In the first the air is stagnant; in the second and third the winds are impetuous.

In the first two the thermometer keeps up all the year at 22 or 23 degrees of the Centigrade scale; (equal to 71 or 72 Fahrenheit); while in the third it ranges between 4 degrees and 17, (equal to from 39 to 62 Fahrenheit.)

The researches of Mr. McClelland, in India, lead to the same conclusion. He found Goitre extremely frequent in one part of the district which he surveyed, while the other portion was almost exempt from the complaint, "although an equality of moral as well as physical circumstances appear to affect the whole. The external Alpine characters of the Province are the same in every part, the inhabitants all belong to the same tribes of Hindoos, and are subject to fewer irregularities in their mode of life than any other people in the world."

The different localities of the villages, in the portion where Goitre was not prevalent, he describes as being as diverse as can well be imagined. "Some are erected on narrow ridges, others in deep valleys, surrounded by abrupt and lofty mountains; others on rugged declivities, between lofty peaks on one side, and deep ravines on the other, into some of which the sun can scarcely penetrate. The different altitudes of these villages vary from 2000 to 6000 feet.

"Facts of this kind have turned the attention of scientific inquirers towards the only other obvious source to which the disorder could, with probability, be attributed, namely, the quality of the water used for drinking. Wherever Goitre prevails, the popular belief assigns it to the water, as a cause; and the more accurately the search is prosecuted, the more strength and likelihood does this supposition acquire. Its very universality is a presumption in its favour. The disease was formerly ascribed to the use of snow water, a notion which originated, I imagine, in its frequent occurrence in Alpine regions. But the people in almost all the valleys of Switzerland drink the water that comes from the glaciers; while Bronchocele is known in some of the valleys only. It prevails also in certain spots where pump water is used, and there the people accuse the pump water of producing it. Besides, Goitre occurs in other countries, where the snow never lies long, as in Derbyshire; and even in Sumatra, where there is no snow. Dr. Bally, a native of a goitrous district of Switzerland, believes that Bronchocele is caused by certain waters which issue from the hollows of rocks, trickle along crevices of mountains, or rise from the bowels of the earth. And in support of that opinion he refers to some fountains in his own neighbourhood, the drinking of the water of which will produce, or augment, goitrous swellings in eight or ten days. Such of the inhabitants as avoid these waters are free, he says, from Goitre and Cretinism. In Captain Franklin's narrative of his expedition to the shores of the Polar Sea, there is the following statement made by his fellow traveller, Dr. Richardson: "Bronchocele or Goitre is a common disorder at Edmonton. I examined several of the inhabitants afflicted with it, and endeavoured to obtain every information on the subject from the most authentic sources. The following facts may be depended on: The disorder attacks those only who drink from the water of the (Saskatchanan) river. It is indeed, in its worst state, confined almost entirely to the half-breed women and children who reside constantly at the fort, and make use of river water, drawn, in winter, through a hole made in the ice. The men, from being often from home on their journeys through the plain, where their drink is melted snow, are less affected: and if any of them exhibit during the winter some incipient symptoms of the complaint, the annual summer voyage to the sea-coast generally effects a cure. The natives, who confine themselves to snow water in the winter, and drink of the small rivulets which flow through the plains in summer, are exempt from attacks of this disease. A residence of a single year at Edmonton is sufficient to render a family bronchocelous. Many of the Goitres acquire great size. Burnt sponge has been tried and found to remove the disease: but an exposure to the same cause immediately reproduces it. A great proportion of the children of the women who have Goitres are born idiots, with large heads, and the other distinguishing marks of Cretins. I could not learn whether it was necessary that both parents should have Goitre to produce Cretin children."

"We are able even to go a step further, and to announce a probable conjecture as to the specific quality of the suspected water. Bronchocele is very prevalent in Nottingham and its neighbourhood; and the vulgar there ascribe it, (so Dr. Manson informs us), to the hardness of the water. The hardness is generally occasioned by the presence either of Sulphate of lime, or of Carbonate of lime. In the one case the remedy is to mix the carbonate of an alkali with the water; in the other it is sufficient to boil it. The well water in and about Nottingham is more or less hard, and unfit for the purpose of washing. Dr. Coindet, of Geneva, declares that the use of hard or pump water in the lower streets of that town brings on the Goitre very speedily. At Cluses, on the Arve, numerous Cretins and goitrous persons are seen in the streets: lofty cliffs of limestone tower over the town, and through its caverns copious streams of water find a passage. The soil in the neighborhood of Edmonton was found by Dr. Richardson to be calcareous, and to contain numerous fragments of magnesian limestone. In a ' Treatise on English Bronchocele,' recently published, Dr. Inglis states his belief that the presence of magnesian limestone always implies the coexistence of the disease. ' Take,' he says, 'that ridge of magnesian limestone running from north to south through the centre of Yorkshire, and margining the shires of Derby and Nottingham. All along that line we have Goitre to a very great extent; whereas, on our diverging to either side, the disease is found to diminish."