On goiters and the stupidity which in some countries accompanies them. Endeavours of Vincenzo Malacarne, from Saluzzo.

Two hundred years ago, V. Malacarne, pathologist and surgeon, published a booklet entitled "Su i gozzi e sulla stupidità che in alcuni paesi gli accompagna". Malacarne was born at Saluzzo, a town at the foot of the Cottian Alps, in Western Piedmont. Goiter and endemic cretinism were prevalent at the time (1789) in the countryside. In 1940-45 goiter epidemics spread through these still endemic regions. On the basis of his own observations on autoptic material, he suggested that the main cause of cretinism was brain damage due to impeding of the blood circulation by the neck swelling, and invited the pathologists of the Po and Aosta valleys to send him the head and the neck of these goitrous idiots for his researches. Today, too, we believe the thyroid and the brain to contain crucial factors of cretinism and assume that iodine deficiency is the main cause of the disease. Yet we do not know either the factor which damages and prevents in the myxoedematous cretin postnatal thyroid growth, or the pathogenesis of deaf-mutism, spastic paraplegia and severe mental deficiency of the neurological, non-hypothyroid cretin. While these questions remain unanswered, ample evidence has been gathered during the last two centuries regarding the practical importance of iodine prophylaxis to prevent these scourges, today referred to as "iodine deficiency disorders".