It was one of the childhood memories that lasts.
I was about eight. We had recently moved to Uranium City. An old guy joined us for supper. I can’t remember his name. I can’t remember why he had been invited to break bread with us. I can’t remember what we ate. I do remember his neck.
The poor guy had this purplish growth on his neck. It looked like a walnut, but was about the size of a MacIntosh apple. It was ugly and looked incredibly painful, but all the adults ignored it. I did my best to follow their lead, but I spent the supper in a kind of entranced horror. As I recollect, I did not even eat desert.
After everyone left, I asked my mother what was on his neck. She replied that it was a “goiter”. Then she assured me that I would not get one because we put salt on our food. This did not make a lot of sense to me, but I do know that’s when I developed the habit of instinctively reaching for the saltshaker at the beginning of every meal.
One can’t take chances about things like that.
I’m no longer eight years old and have access to knowledge of such things via the internet. Thus, I can report that my mother was right. The hideous lump on the guy’s neck was a goiter and salt was the reason why I did not need to worry about getting one.
Let’s start with the basics.
A goiter is an enlargement of the thyroid glands. Contrary to my 8-year-old diagnosis, it apparently is not particularly painful. However, it can cause difficulty in breathing and swallowing. It can change a person’s voice. Goiters are not, in and of themselves, fatal. However, having a goiter significantly increases a person’s chances of getting thyroid cancer. That, my friends, can put you six feet under.
Goiters used to be common. When I was a child, they had become rare – and were usually only seen in old people. A few weeks ago, asked a class of 65 students – about half of whom are nursing students – if they knew what a goiter is. They all looked at me blankly.
That’s something better than in the good old days. Almost no goiters.
Why fewer goiters?
At one level, my mother was right. I did not need to worry about getting a goiter because we had a saltshaker. I am sure she could have explained it if I had pressed further, but it was not the salt that prevented goiters. It was the iodine.
The vast majority of goiters are akin to scurvy. Both are deficiency diseases. Scurvy is caused by a shortage of Vitamin C. Goiters are caused by a shortage of iodine. About 6,300 years ago, Chinese medical writers explained that goiters could be prevented by eating seaweed. This finding was independently reached by people such as Hippocrates (in Greece about 450 BCE) and Galen (in Pergamon – modern Turkey – about 200 CE). Preventing goiters by eating seaweed was based on empirical observation, but for thousands of years, nobody knew why seaweed prevented goiters.
The conceptual breakthrough came as a result of the Napoleonic wars.
Napoleon demanded the production of a lot of gunpowder. Trying to conquer the world creates that kind of demand. Gunpower is a mixture of sulfur, charcoal, and saltpeter (nitrates). Of these three ingredients, saltpeter was the hardest to come by. One production method was to dig a hole, put in vegetable matter, spray urine on top, and fill in the hole with dirt. A crystalline power would eventually form on the surface. Saltpeter. The essential ingredient for invading Russia. Well, that did not work out for Napoleon.
For a long time, turnips had been the vegetable matter of choice for the manufacture of saltpeter. By 1811, Napoleon’s wars overwhelmed the turnip growing capacity of France. A guy named Bernard Courtois tried using seaweed. It worked, but in addition to saltpeter a purple vapor was produced. Courtois investigated and discovered iodine – now listed as number 53 on the Periodic Table of Elements.
Cool.
Scientists quickly made the link between the presence of iodine in seaweed and the proven ability of seaweed to prevent goiters. There were a lot of papers and a lot of speculation. In 1852, Adolphe Chatin demonstrated in a fairly conclusive manner that goiters were caused by an iodine deficiency.
Turning science into public policy
By the beginning of the 20th century, scientists knew that the most common cause of goiters was an iodine deficiency. Goiters were least common near the oceans (all that seaweed). Away from the coast, the prevalence of goiters varied with soils. Food tended to be eaten near where it was grown, so the amount of dietary iodine varied with soil. In the United States, goiters were most common in the Appalachians, around the Great Lakes, and in the Northwest. In Canada, prairie soil was low in iodine, so that was where goiters were most common. In these regions, up to 70 percent of children had small goiters. About one third of them had serious goiters. One thing that really caught the attention of governments was the impact of goiters on recruitment in World War 1. For example, 30.3 percent of potential draftees from Michigan were medically disqualified because of goiters.
Action was clearly needed. People in iodine deficient areas need more iodine in their diet. But there was a catch. Too much iodine was bad as well. What’s more, the clinical effects of too much iodine mimicked the effects of too little. Iodine supply had to be like Goldilocks porridge. Not too hot. Not too cold. What was needed was the nutritional equivalent of baby bear’s porridge. Something just right.
David Murray Cowie, a doctor from New Brunswick working in Michigan came up with the answer. Salt. Almost everyone ate salt. Nobody liked eating too much of it. If Iodine was added to salt, our natural self-regulation of salt consumption would regulate our iodine consumption.
On May 1, 1924 the first food with a specific nutritional additive was launched. The Morton Salt Company introduced table salt containing iodine as an additive into the Michigan market. The labels proclaimed that this salt was not just salt, but IODIZED salt. The label explained that “This salt contains iodide, a necessary nutrient.” With that, the health food industry was born. What’s more, it worked. People eagerly used the salt and goiters became a thing of the past in Michigan.
Word of the miracle of iodized salt quickly spread. Nobody, it seems, liked having goiters. What’s more, preventing goiters is cheap. Even today, after a century of inflation, iodizing salt costs about $1.20 per ton.
In Canada, the first iodized salt hit the market in 1934. The federal government made it mandatory for all table salt in 1949 – which is why the guy I saw with a goiter in 1965 was an old guy (at least by the standards of an eight-year-old).
In less than two weeks, it will be the 100th anniversary of iodized salt. Most young’uns today don’t know what a goiter is. Most middle-aged people in North American have no living memory of having seen one. Goiters are a thing of the past in Canada and the United States. Iodized is now legislatively mandated in 126 countries. According to the World Iodide Network, no country in the world is severely or moderately iodine deficient. Russia, Italy, Vietnam, and about half a dozen countries in Africa are classified as being mildly iodine deficient.
In a month, we’ll be celebrating the 100th anniversary of the first introduction of iodized salt.
Fewer lumps on the neck. It’s something that is better than in the good old days.