Endemic Goiterfoe in Historic China: Its Geographic Distribution
1999, 54 (4):
Endemic goiter, a worldwide endemic disease which relates to geo chemical environmental factors, has a very long prevalent history in China. This thesis discusses the below four issues by analyzing a large amount of Chinese historical document. 1. Ancient Chinese descriptions on endemic goiter’s symptoms As early as 2 500 years before present, Chinese knew the facts that endemic goiter distributes mostly in mountainous areas and prevails mainly in female population. In Chinese historical documents, goiter was called “Ying” (goiter) at first, and then “big neck”. According to modern medicine, “Ying” is the third or fourth degree of endemic goiter, “big neck” is the first or second degree of endemic goiter. Chinese character “Ying” is composed of words “disease”, “ornament” and “female”, its initial meaning might relate to the thought of antiquity people of goiter as the ornament surrounding female’s neck. The fact shows ancient Chinese very early knew that female falls endemic goiter easier than male. By the Southern Dynasties (A.D.420～589), Chinese were able to distinguish between diffuse goiter and nodular goiter. Unfortunately, after the Southern Song Dynasty (A.D.1 127～1 279), goiter was mixed with tumor by many doctors. 2. Ancient Chinese knowledge on the links between goiter and environment Ancient Chinese believed that the prevalence of endemic goiter in some area related closely to the natural environment of this area and pointed out that water quality and landscape were important pathogenic factors of endemic goiter. About 2 000 years ago, they discovered that mountainous areas were main goiter’s epidemic areas so that they wrongly believed endemic goiter resulted from drinking rushing, sandy water and living in precipitous place. Although then doctors knew how to treat goiter sufferers with rich in iodine drugs, until the early of the 20th century, Chinese don’t knew that the real reason for endemic goiter’s prevalence is iodine deficiency. 3. The geographical distribution of endemic goiter in ancient China Because ancient historians and literature writer intentionally evaded recording diseases, the records on endemic goiter in China’s historical document are seldom seen and very fragmentary. But this paper yet collects enough historical data to recover the distribution image of endemic goiter in ancient China’s hinterland. By analyzing a lots of historical records, the author finds the serious prevalent areas of endemic goiter in ancient China mainly include: the Qinba mountainous areas in Shaanxi Province, the western mountainous areas of Henan Province, the west northern mountainous areas of Hubei Province, the Zhongtiao mountainous areas in Shanxi Province, the Taihang mountainous areas in Hebei Province, the Yimeng mountainous areas in Shandong Province, the Three Gorges area, the Minshan mountainous areas in the northwestern of Sichuan Province, the Dieshan and Liupan mountainous areas in Gansu Province, and so on. These areas are situated in the central part of China, so are earlier exploited and are more recorded. But it is not mean other areas without the records are not the prevalence areas of endemic goiter. 4. The causes of distribution change and the socio economic harm of endemic goiter Endemic goiter is a geo chemical environmental disease. Owing to only a little change of geo chemical environment in the past 2 000 years, the spatial distribution of endemic goiter in China remained relatively stability so that the serious prevalent areas of endemic goiter in the historical times was generally coincident with the distribution areas of endemic cretinism in the early of 1980s. But, by comparing and analyzing, we could still find, because of the improvement of translation condition and dietary composition, the distribution scope of endemic goiter reduced and its harm is alleviated and even eliminated in some areas. For example, the western part of Three Gorges area, the eastern foot plain of the Taihang Mountain.
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