Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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310 Surgery and Healing in the Developing World
Table 11. Forearm reflex activity measured pre- and post iodine repletion
Randomized population of 100
Pre-Treatment Reflex Post-Treatment Reflex Number
normal normal 51
low normal 26
low low 0
normal low 2
high normal 9
normal high 2
high/normal low 10
Assessment made at 3 years post-Lipiodol treatment
experience of individual patients, however, but in iteration become more than the
sum of individual improvements within the community comprised of these individuals
previously suffering hypothyroidism. Some of these functional consequences
may be surprising when considered collectively even if predictable when viewed
individually since correction of hypothyroidism allows increased energy output and
development, but also demands increased caloric input and creates remarkably increased
fertility and enhanced resource consumption.
The measurements of hypothyroidism, goiter and fertility in the neighboring
Efe and Lese population showed that they were similarly affected with hypothyroidism
(Table 3). 25 Fertility was low in both the study population at the outset of the
survey and in the Pygmy population as exhibited in the Table 4. 40 Fertility is multifactorial,
with component parts being the rate of secondary infertility based in pelvic
infectious disease, caloric sufficiency with adequate nutrients to accumulate a fat
surplus in women sufficient to commence and sustain ovulation, and other factors
such as duration of breastfeeding. 41 There is no evidence that the rate of pelvic inflammatory
disease or breastfeeding practices changed during the study interval in
the population under surveillance, but fertility certainly increased.
Not only did fertility increase, but maternal and infant mortality decreased, resulting
in an overall increase in the population. Each of these population members
were also increased consumers, since caloric intake adequate for the minimal energy
output of a cretin is not adequate to sustain a person with normal thyroid status and
normal metabolic demands. The caloric requirement increased by at least a third for
each of the individuals treated when they were relieved of hypothyroidism, and the
increased number of these enhanced consumers has meant greater demand on the
environment within the study area. Food production from that which is grown or
gathered was marginal at the time of the original survey and not remarkably increased
despite efforts to do so following medical intervention and the notable population
increase during the period of the study.
The effects of medical intervention on the society as a whole have tempered the
conclusions of an overall success in terms of individual improvement following
medical intervention. As dramatic as the measurements of morphologic markers in
individuals, the functional consequences were no less impressive both for individu-