and the skin moist and warm. He is now a fine healthy appearing boy, 36 inches high. His weight is about 40 pounds. His hair and teeth are fully developed, and his abdomen is natural. He can walk, play, talk, and seems as bright as the other children, and you could not tell from looking at him that he has been a cretin. He is taking about three grains of thyroid extract three times a day at present.

The mother has since given birth to a well-developed child weighing about 10 pounds. I arrived about one hour after it was born and found a dead baby; whether it died during labor or was stillborn, I cannot say. She took thyroid extract during her pregnancy.

Case II: Agnes H., white, American, aged 4 years, measured 26 inches in height, the abdomen 181⁄2 inches, and the weight was 19 pounds. The father was 29 years of age; the mother was

28 years of age; both are living and well. There is one sister seven years old who is bright and healthy. The mother's father died of cancer of the stomach. The other grandparents are living and well. This child did not seem to be normal shortly after birth, and several physicians were consulted prior to the time I saw her.

Her mental condition was undeveloped and similar to Case I, although she made some effort at talking and expressed some meager desire for certain foods. Her physical condition in regard to skin, hair, teeth, tongue, nose, mouth and limbs was about the same as the preceding case, and in addition she had a large umbilical hernia and general anasarca. I could not feel the thyroid gland. The mother has had a slight enlargement of her thyroid gland for several years.

The photographs before the treatment do not show her real condition, as she had been given thyroid extract for about ten days before these were taken, and a great deal of the anasarca had disappeared. She was given one-half grain of thyroid extract three times a day at the beginning and is now taking about two grains three times daily. Improvement was manifested almost immediately, and the photograph shows her at the age of four years and eight months, after eight months' treatment; after taking thyroid. extract she lost about eight pounds, but now weighs 22 pounds and is 31 inches high, and the abdomen is 17 inches in circumference.

Case III: It was impossible to obtain photographs of this case. The patient is Marion K., male, American, white, aged 7 years. The father is 31 years of age and the mother is 30 years of age, and both are living and healthy. There is one sister 5 years old, who is well developed and very bright. The grandparents are living and well. This is a very mild case, or rather a cretinoid state.

He is a cousin to Case II. The boy has never developed mentally as fully as he has physically. He is a large well-developed boy for his age. His skin was cold, and his tongue was large, which seemed to account for the deep guttural voice.

The anus was open, and there was a prolapse of the rectum. He had no control whatever of his bowels. His prepuce was long, and he urinated the same as when a child, and it was impossible for the mother to teach him these customs.

His height and weight were normal. He developed to a certain degree mentally, but his mother thought he had gone backward during the last year. The appetite was normal but he

1

to be fed most of the time. He would play with certain playthings; others he would not notice.

He knew some of his letters and could count some, but there was a wandering, undeveloped condition of his mind which could not be accounted for, only by the partial function of the thyroid gland.

but

On his first visit to my office he would not sit in a chair, kept moving about continually, upsetting bottles, instruments and my inkstand.

He has been taking thyroid extract for four months, and now has full control of his kidneys and bowels; he is developing mentally, and has gone to school the last two months, and has learned his letters; he can draw and write, and seems to be improving.

CHAPTER III– SURGERY

Wound Infection and its Treatment,
with Report of Cases

BY SHERMAN LEACH, M. D., COLUMBUS

The title of this paper suggested itself to me as a result of the frequency with which this condition has been encountered during the past year. Wound infection, as its name implies, is a process due to the activity of microorganisms which are capable of developing in living tissue, such as are represented by the pathogenic bacteria. It is not my intention to consider all forms of wound infection, as the title of my paper might imply, but simply that class of wounds most frequently received upon the extremities, and classified as simple, or trivial, in character.

Moreover, I do not wish to include operative wounds which become infected at the time or subsequently, tubercular, or specific infection. That infective wounds do not receive from us the attention which their importance demands is evidenced by the great number of permanent deformities that we daily see on our streets, and not a few cases that result fatally.

For the benefit of the members who do but very little, if any, surgery, and consequently do not keep in close touch with the various forms of pathogenic bacteria, I wish to review, in a measure, the more important cocci of this group. It is the general practician who usually sees these cases while they are in their infancy, so to speak. While there is a large number of virulent cocci, yet in this connection we have to deal more especially with but one or two groups, the staphylococcus and the streptococcus.

In the staphylococcus group is included the staphy

entrance to the humphans. de a mary exere i

és fa fillustremedy erodas vile the tendency of the saph form is to become localized and to produce in wried dixes.

#kis, however, is not always true as some of the cases will from a diffused cellulitis, which may in all probability Ye wormed for by the presence of both forms of bacili

A knowledge of the above facts enables us to deal more Mcently with his class of cases. While the clinical aspect a usully sufficient for practical purposes a microscopic ▲xamination is the infallible means by which a positive Caprons may be reached

11 a wound shows streptococci present, it calls for carly and free incision, together with thorough cleansing and drainage.

If staphylococci are present less heroic measures will