This complaint, which is common in some parts of Switzerland and France, in Derbyshire in England, and in some parts of Canada, consists of an enlargement of the thyreoid gland. It usually presents a soft, smooth, elastic tumour, which is neither painful, nor tender, nor discolored.

Unless the tumour be very large, it follows all the motions of the windpipe, and in this way it may be distinguished from an enlarged lymphatic gland, or an encysted tumour in the neighbourhood of the windpipe, or even a collection of matter in that neighbourhood. The gland itself is subject to different kinds of enlargements. It may swell from inflammation, chronic or acute: and then it will be hard, and tender, and painful. But it does not seem very apt to inflame, and Dr. Copland is of opinion that it only inflames spontaneously in scrofulous persons.

Bronchocele is not, in itself, a painful disorder; nor does it taint the system, or affect the constitution in any way. It has no quality of malignancy about it. It is always, however, a deformity; and by its mechanical effects, that is, by its weight, when large, and by the pressure it exercises on contiguous parts, it may occasion great distress and suffering, and death itself. The size, .and the effects of the tumour both vary much in different cases; but its injurious effects are not always, though they are generally, in proportion to its bulk. Sometimes there is no more than a slight fulness of the throat, which some persons think rather graceful than otherwise. Now and then, the swelling, after its first commencement, develops itself with great rapidity; but its ordinary progress is slow. It often continues for months or years, without reaching any extreme or very troublesome magnitude. Sometimes it remains stationary for a considerable time, and then suddenly increases without any apparent cause. The worst effects of Bronchocele are its interference with the circulation, and with respiration. By its pressure it may prevent the descent of the blood through the veins of the neck, and give rise to headache, giddiness, noises in the ears, confusion of thought, and a turgid condition of the head and face. Or, by pressing on the windpipe, it may cause hoarseness, wheezing and shortness of breath. It may even cause a difficulty in swallowing. But these effects do not depend altogether upon the size of the tumour. A very large goitre may produce no other inconvenience than what results from its weight, and its unseemly appearance. It may surround all the front and sides of the neck like a thick collar, and rise as high as the ears; or it may hang down in a pendulous lump, and be supported on the chest. The tumour is even said to descend, in some rare instances, so low as to be in contact with the abdomen; and Alibert mentions one case in which the swelling was of a tapering, cylindrical shape, and reached to the middle of the thigh. On the other hand a small tumour, not bigger than one's fist, especially if it happen to occupy the central portion, or what is called the isthmus of the gland, may so press inwards upon the windpipe as materially to hinder the breathing, and even to threaten suffocation.

This disease is much more common in women than in men. Indeed it is seldom seen in England, except in females. Dr. Andrew Crawford states that forty-nine cases were admitted into the Hampshire County Hospital, in ten years, and forty-eight of these were in women. Of seventy patients admitted into the Chichester Infirmary in nine years, two only were males, and they were boys of a very feeble and feminine habit, and backward for their years. Among one hundred and sixteen patients of Dr. Manson's, fifteen were men. Taking an average from these three lists, we have one male for twelve females. In the latter the swelling has been known to come on, or at any rate to increase rapidly, during their confinement in childbed; and it is frequently observed to undergo a temporary enlargement at the menstrual period. Dr. Copland has seldom met with an instance in the female, unconnected with some kind of irregularity in the catame-nial discharge, or disorder of the uterine functions; and he never saw a case in which the disease made its appearance before puberty. In Switzerland, and in some parts of India, where the complaint is much more prevalent than in England, the proportion of males affected is greater; and it often begins, in both sexes, before the age of puberty. It seldom shows itself earlier than the age of ten, yet Dr. Elliotson states that he himself, when in Switzerland, saw goitre in a little boy only four years old; and the natives told him that it rarely made its appearance before the age of six. But chil-dred have been born goitrous. M. Godelle, Physician to the Hospital at Soissons, had a preparation of the body of an infant, which lived a few hours only, and which came into the world with a goitre; the mother being affected with the same kind of deformity. A case is mentioned in the "London Medical Repository" of a child born in Derbyshire with Bronchocele of considerable size. The disease is therefore both congenital and hereditary. Children born of goitrous parents often have Goitre, and Dr. Crawford states that he knew a woman, with Goitre, whose grandmother, father, paternal aunt and cousins, also had it, although they did not all live at the same place, and no other persons in their respective neighbourhoods had the disease.

Bronchocele is prevalent in certain localities, and scarcely occurs elsewhere. And persons who, being previously well, go to live in those localities, often become affected with the complaint; and persons who migrate from those localities, having the complaint upon them, sometimes get rid of it by the mere change of residence.

Some peculiar quality of the air was long suspected of giving rise to this remarkable disease, and it was also attributed to the drinking of snow water. Goitre abounds in the hollows of many mountainous districts; among the Alps, and in the Pyrenees; and in the United States, according to Dr. Condie, the disease is prevalent in some of the valleys situated in the mountainous regions of New Hampshire, Vermont, New York, Pennsylvania; many of these regions abound in limestone rocks. And it is in the deep, close and moist valleys of Switzerland, which lie at the feet of, and between high mountains, that Bronchocele is most common. Several writers, who have personally investigated this subject in places where Goitre is common, concur in the belief that it depends upon insalubrity in the air, arising from the peculiarities of the situation. They affirm that it is most frequent in low, damp, confined spots, where the stagnant atmosphere is seldom stirred by wholesome breezes; and where the sun in summer has great power. And this accords with my own observations in Canada. Five-and-twenty years ago, the disease was very common in many parts of the counties of Kent and Essex. The land was only half cleared of timber, badly drained, and consequently most of the water used by the inhabitants in those neighbourhoods was bad. Since the country has been cleared up, and better drained, the disease seems to have diminished.