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NZMJ, 1923
By Drs. C. E. Hercus and E. S. Baker.
PREVENTIVE WORK IN CANTERBURY
This work was made possible by a grant from the Department of Health, who have given every assistance in the carrying out of the work. In Christchurch two fairly large and typical schools were chosen—West Christchurch and Waltham. West Christchurch has attached to it a branch High School of nearly two hundred pupils, which enabled us to watch results over a longer period. Subsequently a large Timaru school, the Waimataitai school, was selected for further work with the employment of slightly different methods.
The administrative difficulties in carrying out an enterprise of this character are considerable. Authority had to be obtained from the Education board. The consent and co-operation of headmasters and teachers, upon whom considerable extra work falls, had to be obtained. Circulars had to be issued to parents explaining the objects of the work and asking for their permission to administer the treatment. (Specimen circular is attached.) Equipment—such as blue Winchesters, jugs, medicine glasses, etc.,—had to be purchased. Arrangements had to be made for the proper dispensing of a salt which is very deliquescent and is speedily rendered inert by exposure to light. The children whose parents refused treatment constituted our controls. All the children in the schools were completely examined as to height, weight, general nutrition, state of heart, lungs, teeth, throat, etc. The state of the thyroid, as determined by palpation, was noted, and neck measurements were taken. The latter procedure is difficult and cannot replace palpation as a method of detecting changes in the size of goitres, particularly early goitres. The growth factor, which is considerable in the younger children, has also to be considered in measurements were taken. The latter procedure is difficult and cannot replace palpation as a method of detecting changes in the size of goitres, particularly early goitres. The growth factor, which is considerable in the younger children, has also to be considered in measurements. All these records were recorded on a special goitre card on which provision was made for six-monthly progress reports.
In 1921 rather less than half the parents were willing that their children should receive the treatment. In 1922 two-thirds of the parents consented, and a number of children had joined the schools for the purpose of obtaining the treatment.
It seems to be immaterial in what form the iodine is presented, or whether it is given by the mouth, by external application, or by inhalation. The thyroid will take up the iodine from the most stable iodine compound. We adopted sodium iodide largely because this was the method used by Marine and Kimball. The headmasters were supplied with small bottles containing sufficient of the salt for one week’s supply, the dosage being graded according to standards. Immediately before use the salt was dissolved in graduated bottles and administered in medicine glasses in tablespoonful dosage.
ARBITRARY STANDARD OF DOSAGE ADOPTED.—Standards 4, 5, 6, and High School (eleven years and upwards), 120 grains per annum; standards 1, 2, 3 (eight to eleven years), 60 grains per annum; infant school (five to eight years), 40 grains per annum. The method of dosage adopted was to give a weekly dose for ten weeks in each term, of 4 grains, 2 grains and 1 1-3 grains respectively, in half an ounce in water.
Owing to the administrative difficulties experienced in administering the salt in solution we adopted potassium iodide in pill form for the Timaru school. The satisfactory dispensing of iodine salts in pill form required a considerable amount of experiment, but greatly simplified the administration.
POSSIBLE ILL-EFFECTS.—The promiscuous giving of iodine to large numbers of children involved close attention to possible ill-effects, and the teachers were instructed to report at once if there were any complaints of ill-effects from the children. No cases suggesting symptoms of iodine to persons with simple goitre converts it into an exophthalmic one. Nothing of the sort has yet occurred.
RESULTS.—The “casualty list” as might be expected from the peripatetic habits of the average New Zealander, was large. The school population of the two Christchurch schools in which the work commenced in April, 1921, was 1436, on re-examination in December, 1921, 1197 of these children remained, while in April, 1922, only 980 were still at school—a casualty list of one-third. On re-examination, every effort was made to overcome any tendency to bias. In assessment we did not know and took pains not to know, which children had been taking treatment and which had not. In May, 1922, a further examination was carried out, and the results are given in the following tables:—
View Tables 1–4 and circular.
The results of treatment in a small group of children for nine weeks are included. They are of interest as showing how rapidly iodine acts. These figures were obtained by a lucky accident.
In June 1922, prophylactic treatment was commenced at the Waimataitai school, in Timaru, using tabloids composed of potassium iodide, gr. 1; starch, gr. 1-8; sugar of milk, gr. 7-8. The system decided on was to give 2 grammes per annum to all children irrespective of standard. Out of 800 children, 256 agreed to undergo treatment.
The same procedure was carried out as has been already outlined, and after six months’ treatment, during which time 20 grains of potassium iodide were administered, the following results were obtained:— (view table)
The total number of children’s records analysed for these tables was 1514 (1047 in Christchurch and 467 in Timaru.)
By other analyses of our figures we endeavoured to discover if non-adenomatous goitres at any particular age, or of any particular age, or of any particular size, responded especially to treatment, but our figured did not throw any great light on that question.
Marked changes occurred in 65 cases in the Christchurch schools as follows: - Treated – Marked increase 7 cases (1 boy and 6 girls); marked decrease in 16 cases (5 boys and 11 girls). Untreated – Marked increase 36 cases (19 boys and 17 girls); marked decrease in 6 cases (3 boys and 3 girls). In the Timaru school, 5 cases showed marked changes:—Treated—Marked decrease in 2 boys. Untreated—Marked increase in 3 girls.
Summary
Abstract
Aim
Method
Results
Conclusion
Author Information
Acknowledgements
Correspondence
Correspondence Email
Competing Interests
For the PDF of this article,
contact nzmj@nzma.org.nz
View Article PDF
NZMJ, 1923
By Drs. C. E. Hercus and E. S. Baker.
PREVENTIVE WORK IN CANTERBURY
This work was made possible by a grant from the Department of Health, who have given every assistance in the carrying out of the work. In Christchurch two fairly large and typical schools were chosen—West Christchurch and Waltham. West Christchurch has attached to it a branch High School of nearly two hundred pupils, which enabled us to watch results over a longer period. Subsequently a large Timaru school, the Waimataitai school, was selected for further work with the employment of slightly different methods.
The administrative difficulties in carrying out an enterprise of this character are considerable. Authority had to be obtained from the Education board. The consent and co-operation of headmasters and teachers, upon whom considerable extra work falls, had to be obtained. Circulars had to be issued to parents explaining the objects of the work and asking for their permission to administer the treatment. (Specimen circular is attached.) Equipment—such as blue Winchesters, jugs, medicine glasses, etc.,—had to be purchased. Arrangements had to be made for the proper dispensing of a salt which is very deliquescent and is speedily rendered inert by exposure to light. The children whose parents refused treatment constituted our controls. All the children in the schools were completely examined as to height, weight, general nutrition, state of heart, lungs, teeth, throat, etc. The state of the thyroid, as determined by palpation, was noted, and neck measurements were taken. The latter procedure is difficult and cannot replace palpation as a method of detecting changes in the size of goitres, particularly early goitres. The growth factor, which is considerable in the younger children, has also to be considered in measurements were taken. The latter procedure is difficult and cannot replace palpation as a method of detecting changes in the size of goitres, particularly early goitres. The growth factor, which is considerable in the younger children, has also to be considered in measurements. All these records were recorded on a special goitre card on which provision was made for six-monthly progress reports.
In 1921 rather less than half the parents were willing that their children should receive the treatment. In 1922 two-thirds of the parents consented, and a number of children had joined the schools for the purpose of obtaining the treatment.
It seems to be immaterial in what form the iodine is presented, or whether it is given by the mouth, by external application, or by inhalation. The thyroid will take up the iodine from the most stable iodine compound. We adopted sodium iodide largely because this was the method used by Marine and Kimball. The headmasters were supplied with small bottles containing sufficient of the salt for one week’s supply, the dosage being graded according to standards. Immediately before use the salt was dissolved in graduated bottles and administered in medicine glasses in tablespoonful dosage.
ARBITRARY STANDARD OF DOSAGE ADOPTED.—Standards 4, 5, 6, and High School (eleven years and upwards), 120 grains per annum; standards 1, 2, 3 (eight to eleven years), 60 grains per annum; infant school (five to eight years), 40 grains per annum. The method of dosage adopted was to give a weekly dose for ten weeks in each term, of 4 grains, 2 grains and 1 1-3 grains respectively, in half an ounce in water.
Owing to the administrative difficulties experienced in administering the salt in solution we adopted potassium iodide in pill form for the Timaru school. The satisfactory dispensing of iodine salts in pill form required a considerable amount of experiment, but greatly simplified the administration.
POSSIBLE ILL-EFFECTS.—The promiscuous giving of iodine to large numbers of children involved close attention to possible ill-effects, and the teachers were instructed to report at once if there were any complaints of ill-effects from the children. No cases suggesting symptoms of iodine to persons with simple goitre converts it into an exophthalmic one. Nothing of the sort has yet occurred.
RESULTS.—The “casualty list” as might be expected from the peripatetic habits of the average New Zealander, was large. The school population of the two Christchurch schools in which the work commenced in April, 1921, was 1436, on re-examination in December, 1921, 1197 of these children remained, while in April, 1922, only 980 were still at school—a casualty list of one-third. On re-examination, every effort was made to overcome any tendency to bias. In assessment we did not know and took pains not to know, which children had been taking treatment and which had not. In May, 1922, a further examination was carried out, and the results are given in the following tables:—
View Tables 1–4 and circular.
The results of treatment in a small group of children for nine weeks are included. They are of interest as showing how rapidly iodine acts. These figures were obtained by a lucky accident.
In June 1922, prophylactic treatment was commenced at the Waimataitai school, in Timaru, using tabloids composed of potassium iodide, gr. 1; starch, gr. 1-8; sugar of milk, gr. 7-8. The system decided on was to give 2 grammes per annum to all children irrespective of standard. Out of 800 children, 256 agreed to undergo treatment.
The same procedure was carried out as has been already outlined, and after six months’ treatment, during which time 20 grains of potassium iodide were administered, the following results were obtained:— (view table)
The total number of children’s records analysed for these tables was 1514 (1047 in Christchurch and 467 in Timaru.)
By other analyses of our figures we endeavoured to discover if non-adenomatous goitres at any particular age, or of any particular age, or of any particular size, responded especially to treatment, but our figured did not throw any great light on that question.
Marked changes occurred in 65 cases in the Christchurch schools as follows: - Treated – Marked increase 7 cases (1 boy and 6 girls); marked decrease in 16 cases (5 boys and 11 girls). Untreated – Marked increase 36 cases (19 boys and 17 girls); marked decrease in 6 cases (3 boys and 3 girls). In the Timaru school, 5 cases showed marked changes:—Treated—Marked decrease in 2 boys. Untreated—Marked increase in 3 girls.
Summary
Abstract
Aim
Method
Results
Conclusion
Author Information
Acknowledgements
Correspondence
Correspondence Email
Competing Interests
For the PDF of this article,
contact nzmj@nzma.org.nz
View Article PDF
NZMJ, 1923
By Drs. C. E. Hercus and E. S. Baker.
PREVENTIVE WORK IN CANTERBURY
This work was made possible by a grant from the Department of Health, who have given every assistance in the carrying out of the work. In Christchurch two fairly large and typical schools were chosen—West Christchurch and Waltham. West Christchurch has attached to it a branch High School of nearly two hundred pupils, which enabled us to watch results over a longer period. Subsequently a large Timaru school, the Waimataitai school, was selected for further work with the employment of slightly different methods.
The administrative difficulties in carrying out an enterprise of this character are considerable. Authority had to be obtained from the Education board. The consent and co-operation of headmasters and teachers, upon whom considerable extra work falls, had to be obtained. Circulars had to be issued to parents explaining the objects of the work and asking for their permission to administer the treatment. (Specimen circular is attached.) Equipment—such as blue Winchesters, jugs, medicine glasses, etc.,—had to be purchased. Arrangements had to be made for the proper dispensing of a salt which is very deliquescent and is speedily rendered inert by exposure to light. The children whose parents refused treatment constituted our controls. All the children in the schools were completely examined as to height, weight, general nutrition, state of heart, lungs, teeth, throat, etc. The state of the thyroid, as determined by palpation, was noted, and neck measurements were taken. The latter procedure is difficult and cannot replace palpation as a method of detecting changes in the size of goitres, particularly early goitres. The growth factor, which is considerable in the younger children, has also to be considered in measurements were taken. The latter procedure is difficult and cannot replace palpation as a method of detecting changes in the size of goitres, particularly early goitres. The growth factor, which is considerable in the younger children, has also to be considered in measurements. All these records were recorded on a special goitre card on which provision was made for six-monthly progress reports.
In 1921 rather less than half the parents were willing that their children should receive the treatment. In 1922 two-thirds of the parents consented, and a number of children had joined the schools for the purpose of obtaining the treatment.
It seems to be immaterial in what form the iodine is presented, or whether it is given by the mouth, by external application, or by inhalation. The thyroid will take up the iodine from the most stable iodine compound. We adopted sodium iodide largely because this was the method used by Marine and Kimball. The headmasters were supplied with small bottles containing sufficient of the salt for one week’s supply, the dosage being graded according to standards. Immediately before use the salt was dissolved in graduated bottles and administered in medicine glasses in tablespoonful dosage.
ARBITRARY STANDARD OF DOSAGE ADOPTED.—Standards 4, 5, 6, and High School (eleven years and upwards), 120 grains per annum; standards 1, 2, 3 (eight to eleven years), 60 grains per annum; infant school (five to eight years), 40 grains per annum. The method of dosage adopted was to give a weekly dose for ten weeks in each term, of 4 grains, 2 grains and 1 1-3 grains respectively, in half an ounce in water.
Owing to the administrative difficulties experienced in administering the salt in solution we adopted potassium iodide in pill form for the Timaru school. The satisfactory dispensing of iodine salts in pill form required a considerable amount of experiment, but greatly simplified the administration.
POSSIBLE ILL-EFFECTS.—The promiscuous giving of iodine to large numbers of children involved close attention to possible ill-effects, and the teachers were instructed to report at once if there were any complaints of ill-effects from the children. No cases suggesting symptoms of iodine to persons with simple goitre converts it into an exophthalmic one. Nothing of the sort has yet occurred.
RESULTS.—The “casualty list” as might be expected from the peripatetic habits of the average New Zealander, was large. The school population of the two Christchurch schools in which the work commenced in April, 1921, was 1436, on re-examination in December, 1921, 1197 of these children remained, while in April, 1922, only 980 were still at school—a casualty list of one-third. On re-examination, every effort was made to overcome any tendency to bias. In assessment we did not know and took pains not to know, which children had been taking treatment and which had not. In May, 1922, a further examination was carried out, and the results are given in the following tables:—
View Tables 1–4 and circular.
The results of treatment in a small group of children for nine weeks are included. They are of interest as showing how rapidly iodine acts. These figures were obtained by a lucky accident.
In June 1922, prophylactic treatment was commenced at the Waimataitai school, in Timaru, using tabloids composed of potassium iodide, gr. 1; starch, gr. 1-8; sugar of milk, gr. 7-8. The system decided on was to give 2 grammes per annum to all children irrespective of standard. Out of 800 children, 256 agreed to undergo treatment.
The same procedure was carried out as has been already outlined, and after six months’ treatment, during which time 20 grains of potassium iodide were administered, the following results were obtained:— (view table)
The total number of children’s records analysed for these tables was 1514 (1047 in Christchurch and 467 in Timaru.)
By other analyses of our figures we endeavoured to discover if non-adenomatous goitres at any particular age, or of any particular age, or of any particular size, responded especially to treatment, but our figured did not throw any great light on that question.
Marked changes occurred in 65 cases in the Christchurch schools as follows: - Treated – Marked increase 7 cases (1 boy and 6 girls); marked decrease in 16 cases (5 boys and 11 girls). Untreated – Marked increase 36 cases (19 boys and 17 girls); marked decrease in 6 cases (3 boys and 3 girls). In the Timaru school, 5 cases showed marked changes:—Treated—Marked decrease in 2 boys. Untreated—Marked increase in 3 girls.
Summary
Abstract
Aim
Method
Results
Conclusion
Author Information
Acknowledgements
Correspondence
Correspondence Email
Competing Interests
Contact diana@nzma.org.nz
for the PDF of this article
Further Consideration of Endemic Goitre
In Christchurch two fairly large and typical schools were chosen—West Christchurch and Waltham. West Christchurch has attached to it a branch High School of nearly two hundred pupils, which enabled us to watch results over a longer period. Subsequently a large Timaru school, the Waimataitai school, was selected for further work with the employment of slightly different methods.
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