Cord blood thyrotropin (TSH) screening for congenital primary hypothyroidism has been in effect on the island of St. Lucia for the past three years. Umbilical cord blood samples are obtained on Guthrie filter paper and then transported 3,000 miles to Loyola University of Chicago and delivered to the Illinois State Metabolic Screening Laboratory. There TSH is measured by radioimmunoassay (RIA). After three years, 1,789 newborns have been screened, and the mean value is 6.23 +/- 0.13 microIU per ml. This mean value is less than previously reported by us in 1986 (10.23 +/- 0.29 microIU per ml).13 It is concluded that this screening service continues to be possible far removed from the population under observation. No case of primary hypothyroidism has been detected. Our decreased mean TSH value is due to the new method currently used by the Illinois State Metabolic Screening Laboratory. Congenital hypothyroidism will not be missed provided internal controls are established and rigidly observed.
Despite the brilliant researches of chemists, physicists and physiologists, initiated by the labors of Lavoisier and Laplace in 1780, the most important fundamental problem of medical science, tissue respiration, is still admittedly unsolved. Indeed, the casual remark of an editorial writer (1) in the Journal of the American Medical Association, in 1919, that “an answer to the question as to how the all-important oxidations in the body are brought about is almost as obscure to-day as it was a hundred years ago” tallies well with Howell’s declaration in 1924 (2), that “the respiratory history of oxygen ceases after this element reaches the tissues.” The deplorable feature entailed is the widespread obscurity that it perpetuates in medicine as a whole. This is well emphasized by Halliburton’s (3) statement in 1921, that “knowledge of tissue respiration is so scanty that we can say but little of its pathological bearing.”
—In the editorial entitled "A Fortunate Therapeutic Error" (The Journal, October 18, p. 1249), you refer to the beneficial though accidental use by Trousseau of iodin in exophthalmic goiter, to Plummer and his associates at the Mayo Clinic, and also to the group of clinicians at the Massachusetts General Hospital who favor this method of treatment. Experience has taught me that iodin should be used with extreme circumspection in such cases. During the forty-six years that I have been in practice, never have I seen so many cases in which this "somewhat empiric procedure," as you rightly term it, would have, if continued, greatly compromised the issue and life itself. It has been my lot to see several such cases within the last month. In one of these, 30 drops of compound solution of iodin was being given daily by the family physician. The patient going from
The purpose of our Association being the study of the internal secretions, you will surely realize that it would give me great pleasure to initiate this, our first scientific meeting, with at least an outline of the great progress accomplished in recent years. Unfortunately, my remarks will rather tend in the opposite direction, although my purpose, I hasten to state, is to suggest ways and means that may enable us to hope at least, for a better outlook. It happens to have been my lot, in addition to active practice, to edit works which aimed to collate, either in logical sequence, or in encyclopedic form, the progress recorded in the medical literature. This class of work, which has taken up much of my time and labor during the last thirty years, involved a review of all the branches of medicine, including the specialties, fifteen times. From its very start, in 1887, I became impressed with the thought that closer cooperation between the clinician and the physiologist would tend greatly to elucidate our knowledge of disease.
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