The Imperative of Developmentalist Natalism: Endemic Goiter and El Salvador’s Battle against Cretinismo

While early 20th-century physicians knew that goiter did not cause death, it remained worrying for El Salvador’s growing medical professional class. Researchers commonly linked goiter to congenital iodine deficiency and cretinism and, in turn, to degeneracy. In contemporary terms, goiter is swelling of varying size in the anterior and inferior part of the neck caused by significant and longterm how levels of iodine. However, a contemporary or scientific explanation is not sufficient to account for goiter’s socio-historical meanings. The history of goiter research reveals how scientists associated goiters, and people who had them, with social problems, cretinism, idiotism, deaf-mutism, cancers, inhibited productivity, and overall degeneracy. Medical technocrats and other state advisers came to regard people with goiters as reproductive risks.

This paper offers a survey of early goiter research in El Salvador from the mid-19th century to 1944. Through the 1920s, physicians emphasized etiology and transmission of goiter. Degeneracy and delay served as leitmotifs in case histories of individual affliction. But by the 1930s, goiter became a social problem. Physicians in Europe, North America, and Latin America compelled governments to take responsibility for goiter, locating it within broader concerns over nutrition and reproduction, efficiency, and progress. The Salvadoran state’s approach to goiter was shaped by two streams of thought: puericulture and Vitalismo. Puericulture placed Salvadorans in a global conversation about the proper care of infants, young children, and child bearers. At the same time, social thinker Alberto Masferrer’s philosophy of Vitalismo shaped distinctly Salvadoran conceptions of a well-lived life.

Goiter seems to name an observable phenomenon separable from social and political factors. But I argue that it was a product of what I call “developmentalist natalism,” a new form of eugenic thought that permitted El Salvador’s elites to measure, supervise, advise—but never mitigate—ongoing inequality.