An evil vanquished so completely it has been all but forgotten

December 30, 2023 12:56 AM

Cretinism and goitre were among the great medical mysteries of 19th-century Europe. The overlap of the conditions was a source of fascination, as was their geographical specificity. Scientists, medics and armchair experts flocked to the Alps, seeming to discount nothing in their investigations: landscape, elevation, atmospheric electricity, snow melt, sunlight (too much and too little), ‘miasma’, bad beer, stagnant air, incest and ‘moral failure’. ... In 1876, a list of the most promising theories was published; it featured forty different hypotheses. from A National Evil [LRB; ungated]
posted by chavenet (36 comments total)

A fascinating review of an incredible insight and cure--that is, unless you lived in the canton the "do your own research" fascist of the day was in charge of.
posted by maxwelton at 2:39 AM on December 30, 2023 [14 favorites]

This was really interesting to learn about - thank you.
posted by Lorc at 4:20 AM on December 30, 2023 [3 favorites]

A fascinating article - a Swiss friend forwarded it to me the other day. Switzerland, Bavaria and Austria were centres of Covid denialism in the 2020-22 period, it fascinating to see this reflected beforehand.
posted by The River Ivel at 4:39 AM on December 30, 2023 [7 favorites]

Very cool story. I would love to find a way to work this into teaching biogeochemistry. Students tend to find it too abstract to be interesting, but the example of glaciation leaching all the iodine out of the alps and leading to goiters might grab their attention.
posted by hydropsyche at 4:43 AM on December 30, 2023 [18 favorites]

In England, the condition was known as Derbyshire Neck because, as in Switzerland, there were local deficiencies in available iodine in the rocks and water of the Peak District.

In 2002, apparently driven by reaction to 9/11, The Irish Health Minister authorised the distribution of a little packet of Iodine tablets to every person in the country. The argument was that terrists might decide to blow up the Sellafield/Windscale nuclear plant across the water to release a plume of radioactive Iodine ¹³¹I into the atmosphere which would rain down on the plain people of Ireland, get concentrated in their thyroid glands and lead to widespread cancer and early death. It concentrates in the thyroid because Iodine is an essential building block of thyroxine a key hormone regulating growth-and-development. The thyroid has the ability to filter iodine out of the bloodstream and incorporate it into thyroxine. If the only Iodine available is radioactive then that gets concentrated and incorporated and also zaps the DNA in the thyroid leading to mutations and cancer.

You can't stop the radioactive iodine when it is raining down in the very air that we breathe but you can dilute it so that it doesn't accumulate in the beleaguered thyroid gland. That dilution was the function of Minister Harney's gift-wrapped tablets. That's pretty clever and I think we'd all row in behind the cunning plan if it didn't cost someone (like me the tax-payer) something. In this case, it cost €630,000 to deliver three tablets each across the country. It is an exercise for actuaries to decide if, on the balance of probs, this was a sound investment.

In another forgotten tale Jane Pinsent established in the 1940s that selenium was another essential element for mammals with a narrow range of soil concentration: 0.2 ppm is required and 3 ppm is the lower level of toxicity. 1ppm = 1 mg per kg.
posted by BobTheScientist at 5:26 AM on December 30, 2023 [18 favorites]

This is a great narrative. Its structure would be instructive for wannabe mystery writers. It even introduces a Nazi villain near the end!

The story includes examples of science gone astray, such as the everything-looks-like-a-nail effect (when scientists enraptured by the discovery of microbes and genetics latch on these as causative agents) and mass psychology (when the cure is accepted by one canton "not by diktat, but by popular demand.")
posted by kozad at 5:59 AM on December 30, 2023 [4 favorites]

(when the cure is accepted by one canton "not by diktat, but by popular demand.")

"Whole salt" is an amazing bit of (very useful!) propaganda.
posted by clawsoon at 6:01 AM on December 30, 2023 [10 favorites]

What a fascinating article, thanks for the post! I'm sending the link to my public health colleagues.
posted by emd3737 at 6:18 AM on December 30, 2023 [1 favorite]

It's so interesting how the story failed to get told afterwards. It immediately made me think of the opposite case here in Canada, where every schoolchild is told about Banting and Best and we get to watch poorly-acted Heritage Minutes about it. I'm guessing many countries have some equivalent, a healthcare hero who becomes part of the story of national identity.
posted by clawsoon at 6:35 AM on December 30, 2023 [3 favorites]

Neat. I didn't know the specifics of this...

In 2002, apparently driven by reaction to 9/11, The Irish Health Minister authorised the distribution of a little packet of Iodine tablets to every person in the country.

Yes - not uncommon. I live near a nuke plant and have a packet of potassium iodide pills in my cupboard (the local health authority mailed them out to everyone in the region).
posted by Jessica Savitch's Coke Spoon at 7:25 AM on December 30, 2023 [3 favorites]

I’ll have you know that Cretin and Goiter were the number one morning radio team in Kalamazoo for five years running.
posted by dr_dank at 8:01 AM on December 30, 2023 [11 favorites]

I’ll have you know that Cretin and Goiter were the number one morning radio team in Kalamazoo for five years running.

Classic AM thyroidio
posted by chavenet at 8:14 AM on December 30, 2023 [11 favorites]

This sounds so similar to the story of beriberi in the Japanese military and the doctor who figured how to deal with it. As expected, other doctors attacked his theory and for a while only the navy followed his recommendations. The army ignored them, resulting in 27,000 soldiers dying of beriberi in the Russo-Japanese war, compared to 47,000 who died in battle.
posted by tommasz at 8:24 AM on December 30, 2023 [2 favorites]

See also scurvy, which was cured in the 15th century before staging a comeback.
posted by Naberius at 8:43 AM on December 30, 2023 [4 favorites]

Straight from the Institute for Medical History in Bern, here is a short article--with gruesome goiter porn--about this bit of medical history, along with a warning about the dangers of "exotic salt" (I'm looking at you, Himalayan Pink Salt).
posted by kozad at 8:49 AM on December 30, 2023 [2 favorites]

wow, that is a really fascinating story! I love to have access to these forgotten bits of history.

I was *just* diagnosed with Grave's Disease (hyperthyroidism) about 2 weeks ago, so great timing!
posted by supermedusa at 9:21 AM on December 30, 2023 [2 favorites]

Nobody let the MAGA crowd know about this, or the 2024 election will be all about how COVID was designed in a lab to specifically target people who use iodized salt.
posted by Flunkie at 9:40 AM on December 30, 2023 [1 favorite]

Currently, due to modern eating habits like fast food or ready meals and the use of exotic salts, iodine supply is in jeopardy.

I'm really not sure what that means. Are the Swiss getting goiters again?

TBH I'd be pretty surprised if a household that eats Himalayan pink salt would get iodine deficiency (just a guess, tho). Iodine malnutrition is a relatively localized, regional phenomenon, tied to the soil and crops. But if you have significant food imports from other areas, your iodine intake isn't as impacted by local conditions. For example, I suspect people in rural Switzerland eat a lot more seafood today than they did 100 years ago.
posted by ryanrs at 9:48 AM on December 30, 2023 [2 favorites]

My local natural foods store didn't even sell iodized salt until I asked them to. I asked them to because I had a lab come back with an iodine deficiency. I have significant food imports in my area.
posted by aniola at 10:35 AM on December 30, 2023 [2 favorites]

That is very different in degree than the profound deficiencies of the past (e.g. goiter, cretinism).
posted by ryanrs at 10:51 AM on December 30, 2023 [1 favorite]

See also scurvy

Every bloody year, there's at least one new college kid who has no knowledge of nutrition and winds up diagnosed with scurvy after a semester of nothing but shitty takeout food.
posted by Jessica Savitch's Coke Spoon at 11:25 AM on December 30, 2023 [4 favorites]

Every bloody year, there's at least one new college kid who has no knowledge of nutrition and winds up diagnosed with scurvy after a semester of nothing but shitty takeout food.

And people say that pineapple on pizza is a bad thing. For the sake of these youths, perhaps it should be required.
posted by clawsoon at 12:13 PM on December 30, 2023 [8 favorites]

In parts of Australia and New Zealand, the soil is depleted of cobalt, which leads to a type of malnutrition called "bush sickness" or "coast disease" in ruminants.

Here's an article about it from a 1954 farming journal.

Cobalt - its use to control "wasting disease"
Journal of the Department of Agriculture,
Western Australia

Strangely enough, non-ruminants do not need cobalt. Horses and rabbits, for example, will flourish on cobalt-deficient pastures where sheep and cattle are dying. Apparently, cud-chewing animals need cobalt because this element is used by organisms which live in the rumen or paunch. These organisms seemingly build up certain nutrients vital to the welfare of sheep and cattle.

The essential cobalt must be obtained continuously from the diet. Reserves of cobalt which may be accumulated in the liver apparently are of no value. Thus sheep receiving 7 milligrammes of cobalt once a week remained in excellent health, sheep receiving 21 mg. once every three weeks were not so thrifty, while others re- ceiving 35 mg. cobalt once every five weeks developed symptoms typical of cobalt de- ficiency and some died (Lee 1951).

The article goes on to recommend various salt lick recipes, pasture fertilization, and other techniques for supplying cattle and sheep with cobalt. It is written in accessible, practical language, with many prices given (in Australian Pounds).

Bonus: two pages of tractor ads at the end of the article.
posted by ryanrs at 12:13 PM on December 30, 2023 [9 favorites]

By the way, in 2023 "cretinism" is obsolete and considered offensive. Nowadays it's called congenital iodine deficiency syndrome (CIDS).

Here is a world map of iodine deficiency. More specifically, it's a world map of disability-adjusted life years (DALY) lost from iodine deficiency in 2012 in proportion to a million people. I'm looking at this map, and I notice that there are places with a lot of coast line that are at risk of iodine deficiency. And there are mountainous, land-locked places that are doing ok. I imagine this is the result of a combination of typical cuisine and policy.

According to the American Throid Association, 30% of people in the world are still at risk of iodine deficiency.

That is very different in degree than the profound deficiencies of the past (e.g. goiter, cretinism).

Dairy animals in factories get their teats cleaned with iodine, and that iodine ends up in dairy. So dairy is a good source of iodine. Egg yolks are a good source of iodine. But most of the time, all those animals are being treated cruelly, like things rather than living beings. So say you've responded by eating vegan or mostly vegan. You don't eat seaweed and you shop at your local natural food store. What's your source of iodine? If you eat processed food, it's in the salt. Unless they're using uniodized salts to upsell you.

You're right. It's not the extremes of yesteryear. But just because you can't see it, doesn't mean that the trend toward uniodized salt is without consequence.
posted by aniola at 1:42 PM on December 30, 2023 [3 favorites]

Also wikipedia says "Processed food from the US almost universally do not use iodised salt,[41] raising concerns about possible deficiency.[42] "

I think the reason natural food stores aren't selling iodized salts is because then you need to add dextrose as a stabilizer so the iodine is available when you shake it out the shaker. Then they throw in some gratuitous anti-caking agent. People shopping at natural foods stores take a cursory look at those seemingly unnecessary ingredients, and they go for the single-ingredient sea salt. I've watched people do this. I've done it. The natural food store ordering person did this. It's a thing.
posted by aniola at 1:58 PM on December 30, 2023 [7 favorites]

By the way, in 2023 "cretinism" is obsolete and considered offensive. Nowadays it's called congenital iodine deficiency syndrome (CIDS).

“In Franco-Provençal (the Romance speech of French Switzerland and adjacent areas of France), a person affected by hypothyroidism was called a cretin, literally, “wretch, innocent victim,” The word meant simply “Christian” and emphasized the hypothyroid victim's basic humanity.”

Interesting how that word … evolved.
posted by chavenet at 5:04 PM on December 30, 2023 [7 favorites]

Iodine deficiency became more common in Australia when dairy farmers stopped using iodine based products to clean milking equipment and switched to other non-iodine cleaning/sterilisation methods.

Now, people need to get their iodine from seafood or from iodised salt.
posted by chariot pulled by cassowaries at 11:01 PM on December 30, 2023 [1 favorite]

In Poland kids with iodine deficiency used to get sent to seaside holidays "for the air" - more importantly, a diet rich with fresh fish. And yes, I can attest that after Chernobyl we all drank Lugol's iodine to protect our thyroids. Jury's out on how effective that was - my early-Millennial cohort seems to have a high incidence of thyroid wonkiness, thankfully mine is only cysts and a mild hypoactivity but my doctor says that over a third of the women in my generation have something wrong with their thyroid.

Goitre can still happen due to thyroid wonkiness for other reasons, mind you. I know several women (living by the seaside, natch) who had a large improvement in quality of life after surgical removal of thyroid and goitre both.
posted by I claim sanctuary at 11:15 PM on December 30, 2023 [2 favorites]

People shopping at natural foods stores take a cursory look at those seemingly unnecessary ingredients, and they go for the single-ingredient sea salt. I've watched people do this. I've done it. The natural food store ordering person did this. It's a thing.
posted by aniola at 3:58 PM on December 30 [4 favorites
I have also done this.

Decades ago I recall seeing ppl with goiters. Had to suck. Still see just every so often. Such a small thing, such an easy cure, but not small thing if you don't have that cure.

Great story, great thread, thx for posting.
posted by dancestoblue at 1:10 AM on December 31, 2023 [1 favorite]

I'd love to read some patient narratives of the pre-iodine days. Surely some exist, seeing as how this affected an entire country.
posted by Soliloquy at 2:03 AM on December 31, 2023 [1 favorite]

I am a third person who has been baffled by dextrose in my salt.

I would love to understand the chemistry where a dextrose mixture prevents potassium iodide from reacting with the air to form iodine vapor. I would also love to understand the economic decision to use potassium iodide plus dextrose versus potassium iodate, which apparently doesn't have the oxidation problem.
posted by fantabulous timewaster at 11:02 AM on December 31, 2023 [1 favorite]

Stevia also. I was all into it, I was all frowny, I was all about "Fuck sugar! Etc!" and I bought me a big honkin' box of stevia in those green bags and way, way, way down in the fine, fine print is said "Dextrose." or whatever it was, it was goddamned sugar is what it was and is, put in there because if you want *only* enough stevia to sweeten your drink you're going to be going after a bitty white grain about 1/500,000,000th the size of the mustard seed and these companies know we're not going to read the fine print and open wikipedia and get to the bottom of it except for me. Should you decide you're in, one bitty bag will likely last you the rest of your life, and could even pass it down to your kids, who will throw it away reflexively after using it wrong in one ice tea -- even one grain too many and you'll make a truckload of tea disgustingly sweet, it's really gross.
posted by dancestoblue at 12:42 AM on January 1 [1 favorite]

New Zealand soils are ALSO deficient in selenium, which causes "white muscle disease" in sheep and cattle. Some people have speculated that it might contribute to disease in humans, although the case for that in NZ is weak. Nonetheless If I didn't eat animal products and eat imported legumes (the main vegetarian source) I'd probably make sure to have a brazil nut every day just to be on the safe side.
posted by i_am_joe's_spleen at 1:01 AM on January 1 [1 favorite]

The New South Wales government actually suggests pregnant women to take iodine, it's apparently lacking in the soils here.
posted by LizBoBiz at 4:32 PM on January 1 [1 favorite]

When I was a kid (80s), I had never heard of goiter until I read an Agatha Christie book in which a character has had goiter surgery in Switzerland. A Murder Is Announced was published in 1950, which is after the introduction of iodine described in this article, but Switzerland still would have had expertise.

I’ve seen iodized salt cited as one of the possible causes of the Flynn effect, the rise of IQ scores over the 20th century (among many others).
posted by bq at 6:52 AM on January 2 [1 favorite]

This was really great history. As soon as I saw the word "goitre" I said, "iodine" out loud. I've got Hashimoto's thyroiditis, which causes hypothyroidism. The first time my endocrinologist palpated my neck he told me I had a goiter. And then told me to always use iodized salt.

Having read a lot of history of medicine, I wasn't even slightly surprised at all the push-back the doctors were given when they explained their theories and the results of their treatment of patients with iodine. So it always goes. Thanks for sharing this. It was fantastic.
posted by ceejaytee at 10:45 AM on January 2 [1 favorite]