These scattered indications that the hurtful quality of the water is somehow derived from its contact with limestone rocks, receive a powerful corroboration from the results of McClelland's minute and valuable inquiries, which were carried on in the province of Kemdon, south of the Himalaya Mountains.

Mr. McClelland affirms that, in the course of his personal enquiries, which extended over one thousand square miles, and which were prosecuted without regard to any theory, no instance occurred in which Goitre prevailed to any extent where the villages were not situated on, or close to, limestone rocks.

It is stated by Dr. Aitken that Mr. Ceely has found solid aggregations of calcareous particles in the thyreoid glands of goitrous patients at Aylesbury, the soil there being mainly limestone.

Treatment

The first step in attempting the cure of Bronchocele, should be the removal of the patient from the situation of the cause, as medical treatment will be of little service if the patient still remains exposed to the exciting causes.

Previous to the discovery of Iodine, the great remedy for Bronchocele was burnt sponge, which was frequently found effectual. Dr. Manson, of Nottingham, has published the following statement of the results of the employment of Iodine by himself. He had treated one hundred and sixteen patients, of whom fifteen were men, and the rest women. Of the fifteen men, ten were cured, three were improving and under treatment at the time of his publication, one was dismissed for irregular attendance, and one was much relieved. Of the one hundred and one women, sixty-six were cured, nine much relieved, two received no benefit, ten were discharged for irregular attendance, and fourteen were improving under treatment. Of the whole one hundred and sixteen, therefore, there were twenty-six positive cures, or two-thirds of the entire number, and only two positive failures. Dr. Manson found that in some, but not in all individuals, after the preparations of Iodine had been given internally for a certain time, they were apt to occasion headache, giddiness, sickness of stomach, with some degree of languor, and inaptitude for exertion. His plan in such cases, was to suspend the use of the medicine, or to reduce the dose.

The patient may take the following mixture, gradually increasing the dose; if any unpleasant effects, as enumerated above, should occur, the dose may be diminished:

Solution of Iodine.....................A Dram and a Half.

Tincture of Orange Peel............Half an Ounce.

Syrup.....................................Half an Ounce.

Water sufficient to make............Half a Pint.

A tablespoonful may be taken three times a day.

At the same time the swelling may be rubbed night and morning with the Iodine Ointment. A piece-according to the size of the swelling-from the size of a nut to that of a nutmeg, may be used each time. The neck should be well covered with flannel.

Attempts have been made occasionally to remove the tumour by means of surgical operations, which have sometimes been successful, but sometimes otherwise. The three principal of these operations are; extirpation of the whole gland; the passing a seton through the tumour, and so exciting suppuration in it, whereby its substance is broken down and destroyed; and tying the arteries which supply it with blood. The first of these operations, extirpation, has been performed when the wen was small; and has been attempted in large tumours; and in one case the haemorrhage was so alarming that the surgeon was obliged to desist in the middle of his task, and the patient actually died of haemorrhage a few days after.

The insertion of a seton is said to have been more successful; but the seton was followed in one case by ulceration and sloughing, and the patient died.

The tying one or more of the arteries that supply the tumour, and thus trying to starve it to death, has been attended with varied success. The operation was performed by Mr. Coates of Salisbury, and his patient was much relieved for a time, and supposed herself cured. But the tumour gradually returned, and caused her death by suffocation. The operation has also been performed by Sir Benjamin Brodie, and also by the late Mr. Earle; but the average results of the operations are not sufficiently encouraging to tempt to their repetition, except in cases where life is put in jeopardy or made miserable by the swelling; and where the treatment by Iodine has been tried and failed. Sir Thomas Watson mentions an instance, where a Bronchocele was cured by accident.

"A well known and much respected Fellow of the College of Physicians, who has since died at the extreme age of 92, had long been embarrassed by a bulky enlargement of his thyreoid gland. One summer night in Bruton street, as he was walking home from a dinner party, he was operated on by a garrotter, and left senseless on the pavement. A cyst contained in the enlarged gland broke under his assailant's grasp. Much inflammatory swelling followed this violence, and for a while the Doctor's life seemed in some jeopardy. "When, however, he at length recovered, he was able to congratulate himself that the villain, who had carried off his gold watch and gold spectacles, had relieved him of his Goitre also."