TWENTY years ago we1 studied the structure and function of goiter as observed in the Hertzler Clinic and, using the international classification of goiter, compared its histology with that described in other parts of the world (Table 1). From a study of 151 cases we concluded in 1929 that the goiter types in the Middle West were very different from those in mountainous regions of high endemicity. While Swiss surgeons see only 7% diffuse and 93% nodular goiters, we had 53% diffuse forms. While in Switzerland 70.7% of all goiters were fetal adenomas, only 13.9% of the surgical goiters in Kansas were of this type. Sixty-two per cent were colloid goiters, while Swiss surgeons report only 26.3%, and in Switzerland only 3% of all surgical goiters are toxic, compared with an incidence here of 65.6% (Table 2).
It became evident from these comparative studies that Middle Western types of