Hypothyroidism in the Alps

Hypothyroidism is defined as a condition of “mild to severe impairment of physical and mental development due to an untreated deficiency of thyroid hormones”. Historically, the condition has been endemic to regions with diets deficient in iodine. The resulting disorders include goiter (enlargement of the thyroid gland) and the severe stunting of development that in the nineteenth century was called cretinism (Papageorgopoulou, Staub, and Rühli, “Hypothyroidism in Switzerland”, 77). A causal connection between the two disorders only began to be perceived in the second half of the nineteenth century (Merke, History and Iconography of Endemic Goitre and Cretinism, 214, 231–33).
In Europe, Alpine regions are severely deficient in iodine, because glaciation eroded the element during the Quaternary Ice Age. Accordingly, since antiquity, inhabitants of these regions were known to be afflicted with goiter and cretinism; and with the rise of scientific and Romantic travel in the second half of the eighteenth century, these disorders became associated especially with parts of Switzerland and Savoy. Observers also acknowledged, however, that incidence of the disorders could be sharply localized. The differences arose from regional variations in soil geology, which were a legacy of patterns of glaciation, as well as from such accidental circumstances as inhabitantsʼ access to an iodine‐rich salt mine. For example, the disorders were virtually unknown in the higher Jura, which were not covered with glaciers during the Ice Age, whereas goiter and cretinism had been observed and recorded since the Middle Ages in the valleys on both sides of the pass of the Great St. Bernard—the Val dʼAosta and the Rhône valley in Valais. These regional variations mystified researchers attempting to isolate a cause; and while some scientists proposed a connection between the disorders and iodine deficiency as early as the nineteenth century, it was not until the first half of the twentieth century that the etiology was fully understood, prompting effective programs in Switzerland to supplement the iodine deficiency in diet (Merke, History and Iconography of Endemic Goitre and Cretinism, 219–21, 12–22, 67–69; Papageorgopoulou, Staub, and Rühli, “Hypothyroidism in Switzerland”, 80).
The sharp variations of incidence seem to have invited extensive speculation about causes. F. Merke remarks that the nineteenth‐century medical literature on goiter “became increasingly voluminous but also more and more muddled”. Likewise, “fanciful, speculative hypotheses” beset understanding of endemic cretinism, though Merke emphasizes that “the ‘medical’ history of cretinism is . . . much more recent than that of goitre, but the iconographic representation of cretins is centuries older” (History and Iconography of Endemic Goitre and Cretinism, 192, 214, 195). Travel writing stoked the speculation. While rendering certain locales notorious for goiter and cretinism, such as the Rhône valley in Valais or the Val dʼAosta, writers were readily led to compare the causes that had been commonly advanced for hypothyroidism; and finding the evidence geographically inconsistent, championed theories that seemed to confirm the shrewdness of their own personal observations (see, e.g., Ebel, Travellerʼs Guide through Switzerland, 361; Murray, Hand‐book for Travellers in Switzerland, 156; and see Merke, History and Iconography of Endemic Goitre and Cretinism, 219–21, 225–27).
Thus, on the evidence of Mary Richardsonʼs diary, the Ruskins first came face to face with victims of severe goiter and cretinism in Sion, the chief municipality of Canton Valais. Taking a walk through the town, Mary, John, and John James found Sion “dirty and desolate looking”; and in Maryʼs view, “the people [were] all miserable creatures, two out of three hav[ing] goitre very bad, and many of them . . . idiots” (Diary of Mary Richardson, 1833, 69). The perception can be authenticated by evidence, but may also have been preconditioned. It is true that, as confirmed in Switzerland by a national health survey in the 1920s, which was undertaken to determine young menʼs eligibility for military service, the numbers of young males with goiter increased dramatically, for instance, in the portion of the Rhône valley surrounding Sion (Merke, History and Iconography of Endemic Goitre and Cretinism, 29–36; Papageorgopoulou, Staub, and Rühli, “Hypothyroidism in Switzerland”, 82). The Ruskins may have been led to expect this change, however, by popular print culture of travel: in The Tourist in Switzerland and Italy, which was the Jenningʼs Landscape Annual for 1830, illustrated by Samuel Prout, Thomas Roscoe alerts the reader that “[a]t a short distance from Sion" upriver toward Brig, where the district divides “into what is called the Haut and Bas Valois [sic]”, one remarks “a marked difference between the inhabitants of these two portions of the same district”. Injecting judgments about moral character into observations of disease, Roscoe marks “[t]he former”, the inhabitants of the Haut‐Valais, as “an industrious people; simple and inoffensive in their manners, strong and healthful in their persons, and of comely appearance. The latter”, living in the Bas‐Valais, “are squalid and wretched, frightfully deformed with the goitrous swelling, and many of them more or less affected with cretinism” (Roscoe, The Tourist in Switzerland and Italy, 101).
Of the opinions about causes of goiter and cretinism contained in British travel writing of the 1830s that the Ruskins are likely to have read, probably all can be traced to another source, more or less scientific or moralizing in their speculation. In 1827–29, William Brockedon favored the idea that the disorders arose from “dirty habits”. “The author”, Brockedon wrote about himself, “has adopted an opinion, arising from extensive observation, that one of the chief causes of these complaints is to be found in the dirty habits of the communities afflicted. This is an opinion entertained by the clean and healthy mountaineers, who are free from goitre, and by the inhabitants of those valleys where personal cleanliness is regarded: for this the Anzascans [i.e., inhabitants of Anzasca valley], a race of fine men and beautiful women, are remarkable; whilst the dirty wretches where the affliction is found, sty all the winter with their cattle, seldom or never change their clothes, and dread water as if their disease were hydrophobia. Three or four filthy generations produce goitre, and it requires as many of clean habits to remove the punishment for their foul offences” (Illustrations of the Passes of the Alps, “The Simplon”, 4–5 n.). Earlier in the century, others before Brockedon blamed the dunghills in Sion for cretinism, and compared the inhabitantsʼ hygiene unfavorably with the habits of highlanders (Merke, History and Iconography of Endemic Goitre and Cretinism, 226).
Writing in 1838, John Murray III insisted for his part that “careful attention to the circumstances accompanying its [goiterʼs] appearance will show that it is connected with the condition of the atmosphere, and is found in low, warm, and moist situations, at the bottom of valleys, where a stagnation of water occurs, and where the summer exhalations and autumnal fogs arising from it are not carried off by a free circulation of air. It is found in places where the valley is confined, and shut in, as it were—where a free draft is checked by its sides being clothed with wood, or by a sudden bend occurring in its direction—where, at the same time, the bottom is subject to the overflowings of a river, or to extensive artificial irrigation. The conjecture which derives the disease from breathing an atmosphere of this kind, not liable to be purified by fresh currents of air to carry off the vapours, is, perhaps, the one most deserving of consideration”. It was surely no accident that this list of environmental conditions matches exactly (one wonders if even uniquely matches) those surrounding Martigny, where the Rhône makes an almost ninety‐degree bend, and the broad flat of the valley formed a marsh between the extraordinary heights of the Bernese Alps on the north side and the Pennine Alps on the south. In the section of the guidebook devoted to Martigny, Murray circularly applies his general theory to explain the prevalence of cretinism in the locale that probably prompted the theory in the first place (Murray, Hand‐book for Travellers in Switzerland, lix, 156). Ultimately, however, the theory was indebted to a scientist well known to Ruskin, Horace-Bénédict de Saussure, who attributed goiter and cretinism to the climatic factors of heat and stagnant air in Alpine valleys (Merke, History and Iconography of Endemic Goitre and Cretinism, 206–8).
The language used by such writers to describe the effects of hypothyroidism is often blunt in its moralizing implications: expect no lessons in sympathetic imagination with disability to have been taken from Wordsworthʼs “The Idiot Boy”. For Brockedon, cretins are “objects of disgust and pity”; for Murray, “[t]he cretin is an idiot—a melancholy spectacle—a creature who may almost be said to rank a step below a human being. There is vacancy in his countenance; his head is disproportionately large; his limbs are stunted or crippled; he cannot articulate his words with distinctness; and there is scarcely any work which he is capable of executing. He spends his days basking in the sun, and, from its warmth, appears to derive great gratification. When a stranger appears, he becomes a clamorous and importunate beggar, assailing him with a ceaseless chattering; and the traveller is commonly glad to be rid of his hideous presence at the expense of a batz” (Illustrations of the Passes of the Alps, “The Simplon”, 5 n.; Murray, Hand‐book for Travellers in Switzerland, lviii).
Diary of Mary Richardson, 1833, © The Ruskin, Lancaster University.
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