consider each of the most important glands; perforce, briefly, but attempting to cover the points which a nurse should know. One of ever increasing interest and importance is the Hypophysic cerebri, an ovoid reddish gray mass lodged in a depression of the sphenoid bone. It has as many names as an Italian count. Described by Avencenna in 1000 A. D., it was named the "hyporose," but was rechristened by Versalius the "pituitary body," and again by Von Svemmering more appropriately named the hypophysis cerebri.

It consists of two lobes with seemingly quite different functions. The anterior lobe influences, first, the growth of the skeleton; second, the nervous system, and, third, metabolism. A secretory disturbance of this lobe appears to cause: Giantism, a fairly uniform overgrowth from birth; Acromeg aly, overgrowth of peripheral parts, with other symptoms; Epilepsy; Sexual Disturbances; Adiposis Dolorosa, and Infantilism,

etc.

The posterior lobe is equally important, its secretion stimulating, first, unstriped muscle; second, the secretory activity of other glands, and, third, glycolysis.

Preparations of this lobe, obtained from the organs of animals, are used as: A postoperative carminative, oxytoxic, to prevent sub-involution, stimulate lactation, raise blood pressure and occasionally as a cardiac stimulant.

Nurses are more likely to be familiar with the thyroid gland and its functions and dis

orders. Lying anterior to the trachea, just below the larnyx, deep red in color, weigh ing about 30 gms.; it also has two lobes, flat, tapering, wing shaped and joined by an isthmus which in some individuals becomes a third lobe. Disorders of this gland may be due to either hypo or hyper secretion, or merely the mechanical effect of hypertrophy.

No paper of this length could possibly cover what a nurse should know about any one of these disorders.

Hypo-thyroidism is roughly of two types,

the congenital known as Cretinism, and delayed usually termed Myxoedema. Both respond to scientifically administered thyroid extract, but in regulating the dose there is constant danger of overdosing and great vigilance on the part of the nurse as well as a doctor is necessary to recognize the toxic symptoms.

Myxoedema may follow operation for hyper-thyroidism, and is very likely to appear at the menopause where there has been " adolescent hyperthyroidism." A nurse should readily recognize its well marked symptoms.

An extensive paper could likewise be written upon hyper-thyroidism and include nothing but what a nurse should know. The nursing care of patients with Basedowe's, Parry's or Graves' disease, as it is variously called, is most exacting. The ideal nurse should possess self-reliance, poise, will power, infinite patience and tact. The symptoms fall under two groups, first, those due to accelerated metabolism and, second, a long list of distressing disorders of the sympathetic nervous system.

The treatment is either medical, which consists chiefly in removing the underlying cause of nervous irritation, or surgical, which is more frequently successful.

Still another paper could be written on "Endemic Goitre," which, according to MacCarrison, is "a chronic, infectious, but non-communicable disease occurring in more or less circumscribed areas and character

ized by a non-inflammatory and progressive enlargement of the thyroid gland without hyper-secretion and unattended by marked

functional disturbances."

Since we have several "goitre belts" in this country contributing yearly to those suffering from thyroid disorders a nurse will be well repaid who familiarizes herself with their prevention and treatment. It is interesting to know that rats, goats, calves, fishes, etc., may be afflicted with goitre and have been useful to scientists in obtaining

experimental evidence concerning its cause and prevention.

The Para-thyroids, once thought to be embryonic thyroid tissue, have been proven to exercise some protective function by neutralizing toxins in the blood. While but little is known about them their extirpation or disease causes some form of tetany.

Even less seems to be known about the small, reddish gray mass situated in the third ventricle of the brain and called the Epiphysis or Pineal body. So little, in fact, that occult writers have suggested it as the site of the much heralded "sixth sense." The epiphysis appears to inhibit the growth and restrain the development of the reproductive organs and begins to disappear about puberty.

The syndrome, known as Addison's disease, which is no respector of persons, either age or social condition, is no longer attributed wholly to disturbed functioning of the Suprarenal glands. Chromaphil tissues, and perhaps other glands, must be involved, for it does not respond to adrenalin, and the prognosis is bad. However, a product of these glands, adrenalin or epenephrine has a place of ever increasing usefulness in modern medicine and surgery.

Since young children sometimes die suddenly from Thymus asphyxiation, it is well to know that there is a temporary gland by that name lying behind the sternum, which belongs to the lymphatic system. It attains its maximum size at about two years, and is replaced by fat after puberty.

This generation of surgeons has learned. by sad experience the fatal results of removSeveral more ing the entire Pancreas. fortunate individuals testify to the possibility of years of existence without the important external pancreatic secretion, provided a few "Isles of Langerhans" remain to furnish its hormone.

While the Spleen is not usually classed as a gland, it is described as furnishing an "exquisitely assimilatory" hormone which influences glycogenisus and the skeletal muscles.

That the gonads function quite separately from reproduction is now universally recognized. Their destruction or lack of development is manifested by the absence of all secondary sex characteristics and lack of that sublimated energy and all its vast possibilities.

Nor is the medical profession concerning itself particularly with the question of how to revivify old men with one foot in the grave as the newspaper articles would indicate; but rather they attempt to promote the development of children and youths where accident or disease have destroyed these glands. Transplanting interstitial tissue is not new and has its obvious disadvantages. Often the graft "takes" temporarily and then retrogression occurs, but fortunately in some instances not before an atrophied gland has been stimulated to growth and activity. The Ovarian preparations and extracts have an important place in the disorders of menopause-artificial or natural-and prevent the development of many untoward symptoms of body and mind.

After all, the most this little paper can hope to accomplish is to stimulate the curi osity and interest of the readers to further inform themselves concerning this youngest but very important branch of therapeuticsEndocrinology. Bibliography

The magazine "Endocrinology." "The Thyroid Gland "-R. (excellent).

MacCarrison

"Pituitary Disorders "-Cushing (Excellent). "The Organs of Internal Secretion "-Cobb, "The Ductless Glandular Diseases "-Falta Meyers.

"Hormone Therapy "-Harrower (English pub. Interesting, but not up to date).

The safe Midwife is CLEAN, TRAINED, CAREFUL. She is supervised.

She treats only cases of normal labor. She takes no chances, summoning a Physician in case of doubt.

She gives no medicine except as allowed by law, possibly a dose of ergot after the birth of the placenta.

She does not bathe the baby in a tub, until the umbilicus is healed.

She cares for mother and child daily for nine days.

She orders suitable food for the mother, and regular breast feeding for the baby. In towns where she is understood and treated as a human being she cooperates with the local agencies interested in the welfare of mothers and babies.

The midwife is usually considered to be a liability.

Properly treated and understood, she can be an asset.

The midwife is in our midst. We can ignore her and she will fall into devious ways, and always be a liability. We can suppress her, and she will lurk in byways, ignore and evade the law, and be a greater liability.

We cannot force women to accept charitable maternity care, and we should not wish to do so. The suppressed midwife becomes the officious neighbor, who cares for mothers "in an emergency only." The question of whether it is an emergency is always in the hands of the expectant mother. The contrary is hard to prove. Ignored and suppressed, the midwife becomes a lawbreaker, even to the extent of becoming a

to teach her, to learn her habits, her potential value or danger. We can use her to teach her patients the essentials of good maternity care. As we educate her patients, the midwife will either prove her ultimate value or the mothers themselves will eliminate her.

The midwife is. No contrary statement can change that fact. As she now is let us use her for our purposes. Let us get her cooperation. Let us appeal to her pride. Let us get her to help us teach her patients.

When the midwife teaches her patient that cleanliness is one of the essentials of safe obstetrics, that patient will watch her daughter's physicians, as he prepares his hands and attends the expectant mother. The safe midwife is Trained, Clean, Careful. She is Subject to a Kindly Constructive Supervision.

A Midwife Equipment

The following is a clean, sanitary equipment for a midwife. Note in the accompanying illustrations, the smooth leather bag in good repair-dusted and sunned weekly -the removable, washable, white lining which protects the open bag and the contents of the closed bag, namely, Allover apron and cap. Five freshly ironed towels. Boric Acid powder. Silver Nitrate. Ergot. Vaseline in tube. Nail cleaner. Tincture of green soap. Lysol. Hand brush. Squares of sterile gauze and sterile tape. Sterile cotton in small packages. Thermometer. The bag may also contain two clamps not more than six inches long for cord, and