It grows slowly, but finally arrives at such a size that it constitutes a serious deformity. To a slight extent it is by some regarded as an advantage, giving the neck a full and rounded appearance. In Switzerland, where it is very prevalent, it is indeed considered quite essential to beauty. A traveller in that country relates that once he heard some Swiss ladies commenting on the personal appearance of a fine-looking Englishman. "What a handsome man he would be," exclaimed one of them, "if he only had a goitre!" Doubtless the Englishman was well content at the absence of this additional charm.
In this country we have seen quite a number of persons with a tendency to this deformity, especially in districts where limestone water had to be used. This is one of its supposed causes, but in one case now under our treatment, and in others we have seen, it is undoubtedly hereditary. It occurs more frequently in females than in males, and is apt to make its first appearance about the period of puberty. Although not a dangerous, it is a most objectionable complaint on account of the deformity it causes, and, moreover, when the tumor increases in size, it gives rise to many inconveniences by pressure on the large bloodvessels in the neck, and renders the voice harsh and coarse.
When taken early, it can be cured almost without fail, but if allowed to run on for many years the sub-
