Simple Goiter: A Woman’s Disease and a Woman’s Problem to Solve

Most people have a small, butterfly-shaped gland in their neck sitting in front of their trachea. I am no longer one of them. Almost seven years ago I had my thyroid surgically removed along with several lymph nodes and (thankfully) all of the cancer that caused unusual swelling in the gland. Realizing that I knew very little about thyroid history, I did what any curious historian does: I started down a rabbit hole of research on thyroid diseases that brought me not to cancer, but to endemic goiter, sometimes called “simple goiter,” which is typically caused by iodine deficiency. This quiet endemic epidemic of the American interior pops up again and again in medical journals, popular magazines, and patent medicine advertisements from 1800 to the end of World War II.

If you’re not sure what endemic goiter is, you’re not alone. The term “goiter” refers to any general swelling of the thyroid gland. Low blood iodine levels are one cause of goiter. When functioning properly, the thyroid produces two hormones, triiodothyronine (T3) and thyroxine (T4). Both contain iodine. Meanwhile, the pituitary gland produces thyroid-stimulating hormone (TSH) in response to low levels of T3 and T4 and tells the thyroid to grow and produce more hormones. In cases of endemic goiter, swelling is caused by a problem with this feedback loop. Historically, regions with low environmental iodine in water and soils tended to have high incidence of goiter, making the condition endemic. Iodine naturally occurs in high quantities in the ocean and rarely elsewhere.

During the 1920s and 1930s, endemic goiter started to decline in the United States with the promotion of iodized salt. The condition was deeply connected to contemporary ideas of geography, gender, and nutrition. Americans understood the region from the Great Lakes to the Pacific Northwest to be a “goiter belt” and had observed for centuries that women exhibited the swollen neck gland more often than men. In the early twentieth century, cities and countries with high levels of goiter started to add iodine to common consumables, typically municipal water (as was the case in Rochester, NY) or salt.

While some governments, like that of Poland, mandated iodization, the United States left the decision up to corporations and state and local officials. In turn, both physicians and salt manufacturers turned to housewives as the troops they could marshal to protect American thyroids.^[1] Women’s magazines and newspaper columns targeting housewives raised the specter of goiter and reinforced ideas about the duty of white, middle-class women to educate themselves in relation to family health. In this way, the campaign to end simple goiter relied less on government or philanthropic coercion and more on persuasion and stoking concerns about poor household management and diminished female attractiveness. In short, goiter prevention tapped into not only serious medical concerns but also the burgeoning health and wellness trends of the twentieth century.

Many worried that low levels of iodine and goiter led to decreased cognitive ability. Others still feared that goiter became worse over generations and could indicate some sort of familial degeneracy, making goiter research a target for American eugenicists.^[2] Some articles, like one editorial by the Kennewick City Health Officer that ran in The Kennewick Courier in 1923, mentioned that goiter was critical to life function but didn’t provide specifics, merely encouraging parents to opt-in for their daughters to receive iodine supplements at school.^[3] Housewives were expected to educate themselves and their children on the health and well-being of their families. By the 1920s, middle-class white women in particular were encouraged to espouse a form of “scientific motherhood” as described by historian Rima Apple. Knowledge of goiter prevention hit the mainstream near the peak of Progressive Era movements to encourage white middle-class women to view marriage and household maintenance as a profession requiring scientific knowledge.^[4] One columnist, however, started not with any of these arguments but with an aesthetic fear: young women – those most likely to suffer from goiter – were typically considered less attractive with a swollen thyroid.

One example of the intense scientific and home economic approach to goiter health and wellness comes from the husband-and-wife publishing team Alberta M. Goudiss and C. Houston Goudiss. As editor of The Forecast, which pitched itself as “America’s leading food and health magazine,” Alberta Goudiss encapsulated this stance in the January 1936 issue, writing, “Few people think of associating a potato, a head of lettuce, a glass of milk or a dish of stew with the skill of a surgeon, the keen mentality of a lawyer or the patience and generalship of a mother. And yet all of these mental and spiritual qualities are directly affected by the food the housewife puts upon the table.”^[5]

To assist the housewife, publications like The Forecast and women’s sections of newspapers printed summaries of scientific research and advice on family health and nutrition. C. Houston Goudiss, meanwhile, promoted his expertise in nutrition via a syndicated newspaper column titled, “What to Eat and Why,” which answered letters from anxious readers and addressed thyroid health specifically several times in 1938 and 1939. It is noteworthy that the Q&A section of the column almost exclusively responded to letters from women, and Goudiss often explicitly addressed women in his writing. At the end of one article from 1938 on the importance of calcium, phosphorus, iron, and iodine, he concluded, “Every homemaker should make it her solemn responsibility to provide these four in abundance. For only in that way can you insure [sic] optimal growth in children, develop vigorous health in adults, and maintain the highest possible tone of every organ in the body.”^[6] Other newspapers and magazines made less overt but still evident connections between goiter health and motherhood. In the Ely Miner from Northern Minnesota, a long article about goiter prevention took on a decidedly domestic flavor. After the typical information about the importance of iodine in the diet and its role in the body, the article included three iodine-rich recipes: “Baked Apples and Onions,” “Lima Bean Cutlets,” and “Shrimp Chowder.”^[7]

Once salt companies were convinced that iodization was in their best interests, they similarly set about marketing the new product to their primarily female customers. National brand Morton’s Salt advertisements from the 1920s prominently featured the addition of iodine as a health measure. According to the ads, adding the condiment to the shopping list checked one box toward better family health. One advertisement from 1927 emphasized the point so strongly that goiter concerns predominate over the actual branding. It also specifically addressed the role of mothers in preventing their children from developing goiter, described as “a disease that threatens 2 out of every 3 children and makes them physically and mentally backward.” While the statistic seems high (and is uncited) it does indicate the widespread concern about goiter. The Worcester Salt company used a similar tactic in a 1933 campaign touting both the gourmet quality of their salt and the ability of iodized salt to “protect your family against simple goiter and its accompanying physical disfiguration and possible mental backwardness.”^[8] Advertisements addressing iodine and simple goiter ran in print publications both within and far outside the classic goiter belt. Nor were salt companies alone: Ocean Spray touted its cranberry products in Goudiss’s magazine as good sources of iodine, claiming (erroneously) that the sea air and literal ocean spray added the important nutrient.^[9]

Today, most Americans can rest assured that they get enough iodine in their diets. However, ailments of the thyroid gland remain highly gendered and rarely discussed outside endocrinology offices or off-hand comments between women. The gendering of endemic goiter in the early 20th century, in terms of not only who suffered, but also whose work was marshaled to curb the problem, speaks to both present and past assumptions about thyroid health. Since beginning my own journey into goiter research I have never brought up the topic or given a conference paper without someone – usually another woman – pulling me aside and sharing her own connection to thyroid diseases. I think about them – about us – as I work through the history of goiter.

Sarah E. Naramore

Sarah Naramore is visiting assistant professor of history at Sewanee - The University of the South. Her current book project, Medical Independence: How Benjamin Rush Created American Medicine, 1769-1813 assesses the work of Philadelphia physician Benjamin Rush and his attempt to form a uniquely American medical profession and practice.

• Sarah E. Naramore

  https://nursingclio.org/author/sarah-e-naramore/

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