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beyond the range of the calcareous strata,
and therefore the water is not likely to be
charged with carbonate of lirne, which has
sometimes been thought to produce goitres;
there may, however, be gypsum on some
of the mountains above this village. The
surgeon at Brieg, at the foot of the Semplon,
told me, that he attributed the prevalence
of goitres and cretinism, in the mountain villages
in the Haut Valíais, to want of cleanliness,
and to their sleeping in cabins, from
which the air was almost entirely excluded,
in order to keep themselves warm. A deficient
or unwholesome diet, has also been
supposed to increase the effect.
That none of the causes here enumerated
will satisfactorily explain the origin of
goitres or cretinism is obvious ; for goitres
occur where these causes can scarcely be
supposed to operate in any sensible degree.
Thus, at Geneva, though the streets are narrow,
and the areas of the houses are close, yet
the situation is dry, the air may be called
salubrious, and the streets are kept clean. In
personal and domestic cleanliness also, the
Genevese are by no means deficient, yet
they are often affected with goitres ; and
even the children of English families who
reside at Geneva for a short time, are not
unfrequently attacked with an enlargement
of the neck, or with incipient goitres.
In various parts of our own island, the
natives are effected with goitres; but it is,
I believe, always in hilly or mountainous
districts. Soon after our return from the
continent, we visited Monmouth, and to
my astonishment I saw that a great number
of the country people who attended the
market, had goitres of a monstrous size,
that rivalled the goitres of the Alps.
Many of the people thus affected with
goitres came from the forest of Dean,
which is table-land, covered with sandstone
strata of the coal formation, and the limestone
on which they rest, is at too great a
depth to affect the water.
One fact must be generally admitted, viz.
that it is the inhabitants of mountainous or
hilly countries who are principally affected
with goitres, for they rarely or ever occur
among the natives of low or level countries,
at a distance from the mountains.
But we cannot ascribe the existence of
goitres to the action of carbonate of lime
alone, as the natives of mountainous dis-
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