within the last several years that a movement of this kind has been started. I believe that if our officials, both County and Municipal, would establish country homes an dopen air play grounds for our children, they would leave for themselves, monuments that could never be effaced and leave to the coming generation a better and a happier manhood.

PREVENTIVE MEDICINE; REGARDING CHILDREN.*

By CAROLYN E. ZIMMERMAN, Newport. While I was reading the card that came from our secretary, as to what subject I would select for a paper, my door bell rang, I answered, there stood two boys almost breathless, one said come quick, may be you can save a boy, who was covered up in a sand bank, we brought him home, but we cannot get a doctor.

I hurried on with the boys, but others had come in before me. But the lad of thirteen was past human aid.

The mother said she had forbidden him going to the sand bank where they had gone to play. The scene, of course, was like those at all homes where one is torn from the midst of loved ones, and was very sad. Then came a thought to me; had we a place where children could play and danger be at a minimum, that life would perhaps not have been sacrificed.

While I have thought of park and playground for a long time, this scene, however, impressed upon me so forcibly the fact that we as a profession, know how very importantit is to have a place where boys can work off some of their surplus energy in various exercises.

So that brings before us the necessity of parks and playgrounds as preventive medieine. At Fourth and Overton, you all know that children skate by the hundreds; we must drive with great care, lest one may be injured. They seem to have a good time, and the street is the best that Newport has to offer. But we know not, what some man or woman suffers. whose nervous tension is such, that the noise made by the skaters is almost beyond endurance.

When I was a child, we needed no playground, everything west of York, east of Monmonth and south of Ninth, was open country and woods, everywhere was playground.

We had hills for coasting, frozen over ponds for skating, and no need to go to the Zoological garden, for we had cows, goats, pigs, geese, ducks and chickens on the streets, those animals kept the town cleaned up and

*Read before the Campbell-Kenton County Medical Society

in a measure, it was preventive medicine, for garbage in those days was not collected. That, of course, was a half century ago, our city is now crowded, and all things have materially changed. The servant girl problem has forced many people to live in flats. Consequently so many children are raised within four walls, and on the street, and the modern conveyance of this age has increased the danger on the streets.

The little children want to get out, when they are able to crawl, and see a door open, they get outside as quick as a wink, and when it can walk, it runs away. Why? From fear If you that it must go back into the house. put a hat on your head, a child of 8 or 9 months, knows you are going out, and puts up its little arms and wants to go too. We know that all things alive turn to light and air.

With all the milk, food and shop inspection, and the great fight against the tubercle bacillus, and the report of preventable diseases, the average life is a little longer than twenty years ago.

I do believe that all people whose span of life reaches four score and more years were not born, neither were they reared in a crowded city, but somewhere in the country or the country village.

During the four years of the Civil War 250,800 fell in their ranks, and during the same time 700,000 died from tuberculosis. That takes us to another problem. What can be done with patients who are too weak to go to work, but they are able to hold and infect the child. We ought to have at some time, and I hope not in the far future, in every state, a sanitarium with hundreds of acres of land. In Kentucky and Virginia, in the mountainous regions, the land is plentiful to be had where all tubercular people, rich and poor, young and old, in the early and late stages, classed according to stage and circumstances, they should be permitted to marry. but unsexed so there would be no offsprings. Some would be able to work and earn some money, they could carry on their own business and manufacturing could be done, sent out into the world in general by complete sterilization, without any danger to the outside world, and not until that is done can we look for a lower death rate.

infect others.

Now that is only one instance. Could that man have gone to some tubercular colony, he could have earned a little, and perhaps the son-in-law might be alive to-day.

Another one, a woman of fifty, coughed and spit up a large quantity of pus, a young woman who is pregnant, is taking care of her mother. That is no place for her, but there is no getting away from it. Here, too, the danger would be less if there were a place to go. It would be a great expense for the State to take care of one. but how many others could be saved, and be productive to the State.

There was a patient examined at my office more than two years ago, he was told he had tuberculosis, he said Dr. So and So. of Cincinnati told him the same four years previous. So he has had the disease now for six and a half years and he still goes to the factory, and only now presents the appearance so characteristic.

In 1897 I wrote an article to the Cincinnati Enquirer, that spitting on the sidewalks should be prohibited. Some one told me I must be crazy, to want to tell the people where they should expectorate. I said maybe I am crazy, but the appearance of the sidewalks in the early morning is nauseating. You all know that much has been done to lessen the nuisance, so all things done must have a leader.

New York with all its people and money, too, applied to Dr. Geier, of Cincinnati, to lead in their Bundle Day. So it behooves us to lead and not let the social workers be the leaders.

It is therefore the opportunity and the duty of the physician as a public spirited citizen, to exercise foresight in this matter before business and material interests have so much encroached upon the available spaces, that their conversion into parks is so expensive as to be almost prohibitive.

Luther Burbank, Stark Harrison and others who experiment with plant life, do not plaut anything within the shadow of a tree, but out in the open sunshine and air, and watch them from the first apeparance to maturity.

Now we have to deal with human plants, and what do we offer? We have inspectors to look after the inspection of animals and quarantine whole states. to prevent the spreading of disease. and what can we do only look on, as the consumptive sleeps with and takes care of children and yet we cannot interfere, and when a consumptive dies the house is fumigated after hundreds have gone into the

ought to be done inmediately after death.

Millions are spent on sanitariums for the cure of consumption, while no provision is made to give children light and air which would largely prevent the condition, which sanitariums try to cure. Then again no house should be built, that has only one window in a room, and all old houses should be inspected and the landlord be compelled to remodel the place to give proper ventilation and light, so our children get a better start.

Cincinnati has a nurse who takes tubercular children to spend the day at the Day Camp, and the open air school is for the same purpose; it does improve the condition of the children.

Those of you who have visited Golden Gate Park in California, know how well that place is equipped in caring for children, the nurse brings a great number of them every day and looks after their wants and returns them at night, at a small cost to the parents; then again mother's take turns about in taking out the little ones that leaves some mothers at home to look after the welfare of the rest of the family.

Now what has all this to do with preventive medicine? In my mind it has much to do If children have outdoor exercise with it. they are happier, because they feel better, they are not sullen, disobedient and quarrelsome; they are more willing to do something, and are not so apt to steal, they are tired. and seek their bed earlier, and are not apt to go to, or hang around show places to meet whomsoever they can. And our juvenile court would not have so many delinquents.

Now, what we should do, is to follow the infant from birth to maturity. First we deliver the mother, see her as often and as long

as we see fit, then dismiss her.

While that little helpless infant is one of our best assets, it is often at the mercy of those around it, born perhaps to poor or careless parents. There is where our advise should be given oftener than it is, as to the care of infants and keeping them out in the sunshine and air.

Then we reach the age when they should attend the kindergarten, not so much for the learning, but but for discipline which our American children lack.

The kindergarten should be under the head of the public school, and medical inspection should begin right there. So much good has been done along this line. Parent's attention has been called to the necessary treatment to nose, throat, eyes and teeth, and that good work in Newport now lies asleep; but perhaps there will be a day of resurrection.

Then comes the proper school age at six years. There ought be only one-half day ses

sions, until they reach the eight year, because an energetic child will fret itself into a nervous state in trying to keep up with the work, when older they grasp the work quicker. The other half day spent in the open, would better fit them for next day's work.

Then we reach another age more critical, the boys slip away to the swimming hole on the river, they are fearless and lack caution, and every summer the water collects the toll.

At this age a walk to the playground would be interesting, and the return from the ball game or other exercise would promote an appetite for the evening meal, a good night's sleep, bright eyes, a clear mind, resisting power to disease, and they would be more capable and obedient. I believe that 50 per cent. of our high school girls menstruate scantily and irregularly, and both male and female are below the average height. The playground is not only for recreation, but also for the upbuilding of the moral character of boys and girls. Games provided which exercise body and mind at the age from 16 to 18 are needed, at that time they resent observation as to where they go and what they do, then is the time when they need skating, coasting and the proper dancing.

So what we would have appear in a nation's life, can be done in the public school. If this movement was begun, I know the children would do their part, and when a day would be set aside for a stroll to the woods not one child would be absent at the appointed time.

We have no place for a Sunday school picnic, or a place to observe a sane fourth of July, or Arbor Day; we talk about it and that is all the children know of it; we have no where to go, to observe May Day, where all things that spring from the earth are in full dress and the violet blooms unseen.

We want a place where there can be a picnic every day, not one or two acres, but nothing less than fifty. The auto bus has come to stay; the young should walk, the old can ride.

Our juvenile court is run at the enormous cost of over four thousand dollars per annum. All honor and respect to the court. But so few are benefitted for the amount of money spent. The number of delinquents advised or sentenced are most all beyond redemption, and those that are not beyond recall could be uplifted in our park and playground. If we take four times four thousand and apply it in the purchase of land for playground and park, it would benefit not a few but thousands and thousands not only for four years but for

ever.

Newport, I know, cannot own a park beyond its limits, but it wont be long until a great area will be in its boundary and no land

to be had at a low figure. Whatever the profession as a body will advise can usually be had, because the people look to us for advice in all things pertaining to the health of the State. So, therefore, the physicians and the architect should be the leading spirits in the hygiene of the masses, as they are best fitted to direct such movements, and not lag and leave it to the laity and the social workers who have less knowledge and appreciation of the real requirements of the situation. We are aware that our best asset is a healthy young man and woman. So let us do more than tie the umbilical cord and set free the little wriggling baby to grow the best it can, often among people who know not its worth, nor the value of medical inspection.

SOME THYROID FACTS.*

By GEO. W. HERMANN, Newport. That iodine is the active agent of the thyroid secretion (para-thyroid) is now absolutely established. The thyroid product is an iodized globulin.

King, over a century ago, traced the thyroid secretion to the lymphatics and showed that the fluid as well as the colloid passed from the thyroid vesicles to the lymphatics of the neck.

The more recent investigators have shown that the product of these organs passes into the perivascular lymph spaces; being then transferred to the larger cervical lymphatics, they are discharged by the right and left lymphatic ducts (thoracic ducts) into the subclavian veins and by way of the superior vena cava into the right auricle.

The removal of the thyroid only, produces morbid phenomena, the severity of which depends upon the age of the animal, the younger the animal the greater the morbid effects, though life itself is not necessarily endangered in the young. The animal fails to develop. The testicles remain small and fail to develop and even to descend, the ovaries are as a rule also atrophied.

Sterility due to nonformation of semen has been noted. Pregnant rabbits abort, hens produce very small eggs or none at all. The skin is rough, coarse and squamous, being in some animals considerably creased as in the aged and in others swollen, hard and resistant, as in myxodema. The hair becomes coarse and shaggy, losing all luster and tends to grow irregularly and falls out. The temperature, normal at first, steadily decreases until death ensues. The removal of the thyroid reduces the resistance to infections.

*Read before the Campbell-Kenton County Medical So2ets.

On the whole the removal of the thyroïd gland alone gives rise in the young first to arrested growth, especially marked in the skeletal bones and sexual organs; second, to myxoedematous thickening of the skin, and third, to a low grade of intelligence with gen eral apathy-as the syndromes recognized under the term cretinism, while in the full grown it causes the condition known as myxoedema.

Removal of the thyroid and parathyroid causes early death, while the removal of the thyroid alone as we have just seen is followed by a prolonged post-operative life.

Even when the thyroid is left in situ and the four parathyroids are removed we witness a typical syndrome, the prominent feature of which is spasm and convulsion tendency; which may range from tetany to violent epileptic paroxysms with foaming at the mouth during which attack the subject may die.

Herbivora, rabbits, sheep, oxen, horses, etc., whose food contains much less nuclein and other substances capable of forming toxic wastes, suffer less from tetany than do carnivora, such as cats, dogs, foxes, men etc., whose food contains considerable of these noxious and spasmodic bodies.

The thyroid gland has long been known to neutralize or destroy toxic wastes.

This explains also the beneficial and sometimes curative effects of thyroid extract in the tetany of gastro-enteritis especially in

children.

The fact that toxic wastes are destroyed under the influence of the thyroid extract is shown by its marked action in puerperal eclampsia. Thyroid proving curative when given in large doses.

Sange found in the study of 133 cases that the thyroid enlarged and reached its maximum about the fifth or sixth month of pregnancy and that albuminurea occurred most frequently among cases which did not show this enlargement; hence the beneficial effect of thyroid extract. I have found nothing to compare with the thyroid extract in giving relief to the morning sickness and nausea of pregnancy.

Turro, the Italian physiologist, found that the juices of the swine and sheep thyroid dissolved almost entirely the comma, typhoid and anthrax bacillus, the bacillus coli communis and the streptococcus.

There is clinical and experimental evidence of a connection of the thyroid with the sexual system of men and higher mammals through its secretion, in that a lack of thyroid secretion influences sexual activity adversely; that sexual activity whether it be physiologic or pathologic, causes an over

activity of the thyroid, and that this hyperthyroidism constitutes an index to the toxemia of pregnancy to counteract which the thyroids raise the antitoxic protective power.

There is abundant clinical evidence in support of the theory that what is termed a physiological overactivity of the thyroid is a valuable safeguard against the toxemia of preg

nancy.

Evidence is accumulating to show that among the functions of the thyroid gland one of the most important is a protective action against circulating toxins. It seems reasonable that the thyroid gland among its antitoxic functions includes that of combating poisons absorbed from the intestinal tract.

Lane, Russell and Carson have all seen the removal of colon and sigmoid followed by the shrinking of a goiter.

Easterbrook after a careful study of the influence of thyroid extract in a large number of cases of various kinds, concluded that thyroid is a profound catabolic stimulant and that it greatly accelerates splitting up and oxidation of tissues.

Thyroid in excess produces tachycardia, tremor, headache, sweating and prostration, symptoms of Graves' disease.

The effects of thyroid extract on temperature are also well known. A rise of temperature has been observed in animals after the administration of thyroid.

It produces fever and is undoubtedly a pyrogenic agent.

That thyroid extract in overdoses does quicken the pulse, raise the temperature and cause loss of weight admit of no doubt.

Levi and Rothchild have shown recently that a large number of diseases attended by hypothermia or subnormal temperature, such as cyanosis, neuralgia, chilliness and so forth, yield to thyroid treatment.

From the standpoint of therapeutics and immunity, this fact is of commanding importance since it places in our hands a lever by means of which we can control the vital activities through the thyroid apparatus and enhance as we see fit the functional efficiency of the process through which the body protects itself from disease.

In the earlier part of the paper we followed the secretions of the thyroid and parathyroid to the heart and thence to the pulmonary alveoli.

Under the conditions it is very evident as to how the thyroid secretion enters the general circulation, it is absorbed by the red blood corpuscles and also by the plasma and distributed throughout the body.

Oswald has termed the thyroid secretion "thyroglobulin" and it corresponds with a constituent of the blood which renders micro

organisms vulnerable to phagocytes, namely Wright's opsonin.

It has been shown experimentally that leucocytes are able to ingest bacteria only after the latter had been prepared, so to say, by some substance in the blood plasma.

Up to the present time very little has been determined concerning the source of the opsonins but all investigators state that the opsonins exist in the blood serum and not in the leucocytes.

The opsonins of Wright has the property of resisting the bacteria and preparing them for ingestion by the leucocytes.

Now let us see of what value is the thyroid extract as a therapeutic agent.

The official preparation in the U. S. P. is the glandular thyroid sieca or the dessicated. thyroid gland, one part of which represents about five parts of the fresh gland. Its use is deemed dangerous by some. In truth there is no agent at our disposal whose effects can be controlled with more accuracy, if the symptoms it provokes are watched and if fresh preparations of thyroid are used.

Small doses one-half to one and one-half grains seldom prove excessive. The pulse may be raised slightly and there may be a rise in temperature of one-half to one degree, this is a result of exhausted metabolism, an expression of the remedy's toxic action.

Conversely when larger doses are given such as those employed in obesity, beginning with three grains three times per day and gradually increased, the hypermetabolism to which the reduction of flesh is due, keep the patient on the verge of a depressor action and more or less suddenly the pulse becomes

faster.

Instead of being firm and somewhat harder than usual as in the case when the tonic phase of the thyroid action prevails, the pulse is softer and yields readily to pressure. The patient may complain of vertigo, weakness and palpation. The two conditions are radically different and therefore the danger signals of depressor action are clearly defined.

It is always best to discontinue the drug when the untoward symptoms occur and to employ smaller doses when the treatment is resumed. Thyroid preparations have afforded beneficial results in various disorders.

Their mode of action in myxoedema and cretinism is self-evident. In the various diseases due to lowered catabolism or the accumulation of waste products in the blood, such as tetany, puerperal eclampsia, epilepsy, the disorders of menopause, asthma and rheumatoid arthritis the beneficial effect of thyroid treatment has been noted.

It enhances the nutrition of osseous tissue and the process of repair, hence the improve

ment noted in osteomalacia, rickets, osteomyelitis and the delayed union of fractures.

In infectious diseases including asthenic pneumonia, the exanthemata of childhood and typhoid fever, the value of thyroid preparations in small doses is readily accounted for.

They attach directly the pathogenic organism by rendering it vulnerable to the attacks of phagocytes and the bloods auto-antitoxin and insure the work of destruction by stimulating the governing center of the body's defensive mechanism.

Thyroid medication has not received the attention it merits in the treatment of thyroid enlargement in young girls just past puberty.

In these patients a parenchymatous enlargement often develops by reason of the great metabolic demand made upon the resources of the thyroid during rapid growth.

Small doses of thyroid gland twice per day in such cases have a remarkable effect in reducing the struma to normal size.

Thyroid gland on the other hand is strongly contraindicated in Graves' disease.

In pathologic obesity the behavior of thyroid is extremely uncertain.

The use of thyroid is strongly recommended in children suffering from adenoids.

In early cases and in doses carefully adjusted to each case it appears to make good, but after the condition has progressed to a point of mouth breathing, resort should be had to the surgeon.

Children bear thyroid preparations much better than adults, perhaps because their active thymus is able to neutralize the excess activity of the thyroid extract.

We must conclude from the foregoing facts just given, that the thyroid secretion is in some way connected with the process grouped under the term immunity. 1st, that the secretion of the thyroid is an active factor in the immunizing process; 2nd, that it takes part indirectly in the process of increasing the functional activity of the adrenals and general oxidation and metabolism, and 3rd, that the resulting increase in the functional activity of the organ which produces these protective substances correspondingly augment the blood in the quantity of these substances.

In spite of the extraordinary keenness of diagnostic power which has been developed in internal medicine, the painfully exact studies in pathological histology and in physiological and pathological chemistry, the widespread activity in pharmacological experiments and the effort of the manufacturing chemist to supply new drugs, the view is prevalent and rightly so, in the treatment of internal diseases that we have more to hope for the future than to be trusted to the present.

We can diagnose disease, describe it and