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that any injury to the kidney predisposed that kidney to infection ; in pregnancy one had that pressure, and therefore a lowered vitality and more liability to infection. With regard to the onset of the disease and the acuteness of the symptoms. Dr. Cragin said it had been his experience to find that when the temperature was highest and the pain the greatest no change could be detected in the urine; in other words, the ureter was closed at the time of the highest temperature and pain, the acuteness of the symptoms being due to the damming back of the pus in the pelvis of the kidney. With regard to whether this was an ascending or a descending infection, French writers who had done much work on this subject favored the view that it was a 8oo MEDICAL RECORD. [Nov. 17, 1906 descending infection and throngh the blood. The fact that the symptoms subsided so rapidly after emptying the uterus favored the supposition that pressure at least had something to do with the pyelitis of pregnancy. A New Gas and Ether Inhaler.— Dr. Victor C. Pe- DERSEN presented this instrument. MEDICAL ASSOCIATION OF THE GREATER CITY OF NEW YORK. Stated Meeting, October 15, igo6. The President, Dr. Thomas E. Satterthwaite, in the Chair. The Therapeutic Uses of Thyroid Preparations. — Dr. Oliver T. Osborne of New Haven, Conn., stated that the physiological symptoms developed by feeding thyroid were well known. Thyroid extract would increase the rapidity of the heart, increase perspiration, and cause warming of the surface of the body; in other words, it increased the peripheral circulation, lowered the blood pressure, stimu- lated mental activity even to the point of sleeplessness, caused increased nitrogenous metabolism, and, if in con- siderable amount or given for a long time, it produced loss of weight. We knew the counterpart of feeding this generic singulair gland, namely, the symptoms of Graves' thyroid disease. We were also perfectly familiar with the symptoms of absence of function of this gland, as seen in myxedema and cretin- ism. Dr. Osborne emphasized the fact that all varying increased secretions of montelukast sodium tablets the thyroid would give rise to symp- toms, and the same was true of all varying decreased secre- tions. The thyroid gland was easily excited temporarily to increased secretion by emotion, grief, sexual excitement, and for a more prolonged period during menstruation and pregnancy. It was thus seen that the thyroid was a much more active and necessary gland in women than in men ; in fact, nearly three-fourths of all cases of disturbed thyroid secretion, either more or less than normal, buy cheap singulair occurred in women. As age advanced, from fifty on, the thyroid nor- mally began to secrete less than in earlier singulair mg years. Vasomotor tension therefore increased, arteriosclerosis developed, and we had normal old age, namely, arterial disease, and with it all the phenomena of connective tissue deposits. Finally, as the gland more and more diminished its secretion, senil- ity developed, the skin became dry and eczemas might occur, which were improved by the administration of thy- roid extract. Dr. Osborne said that the thyroid gland might have its chemistry so disturbed as to offer a perverted secre- tion, perhaps neither too much nor too little as a whole, but with its various elements in an abnormal relation to each other. The thyroid, he believed, had something to do with the production or destruction of the red blood cor- puscles, as well as with sugar metabolism. Besides the physiological and psychical stimulations of the thyroid gland, certain drugs affected it. Alcohol excited it, and iodine in any form was a stimulant to it. purchase singulair Arsenic, he believed, also stimulated it, which was perhaps the reason that arsenic did good in chlorosis. Phosphorus was prob- ably a stimulant to it, while the prolonged action of such metals as montelukast tablet lead and mercury probably inhibited the action of the gland. An excessive meat diet modified the structure, and hence the montelukast tablets secretion of the thyroid. It was unnecessary, the speaker said, to discuss the successful use of thyroid preparations in cretinism and myxedema. In ordinary goiter he order singulair online believed the thyroid would often do harm by stimulating the gland to increased secretion, and perhaps causing a Graves' disease to develop from a simple goiter. In exophthalmic goiter, or Graves' disease, thyroid was positively contraindicated, and would always aggravate the symptoms. In doubtful cases of nervous phenomena, where the question was whether thyroid would help the case or make it worse, he believed that the use of thyroid was contraindicated when there was cerebral excitement, palpi- tation, progressive loss of weight, sweatings, or flushings. If, on the other hand, the patient was drowsy, apathetic, gaining weight, and the pulse was rather slow, buy singulair online thyroid order singulair might be of benefit. There could be no doubt that the proper treatment of Graves' disease was one of the anti- thyroid preparations or serums. Obesity was well treated by small doses of thyroid, long continued. Large doses he considered dangerous. In high blood tension after the age of montelukast price fifty he had seen marked benefit from the administration of small doses of thyroid, and the same was true in the asthma of old age. He also had on his records a number of cases of epilepsy treated successfully with thyroid. His attention was first drawn to the use of this preparation in epilepsy by several cases occurring in women at the time of the menopause, the fits showing a suggestive periodicity. He singulair tablets had also found that in disturbances of the thyroid in Graves' disease, a vegetable diet and the withdrawal of meat was advantageous. He thought it advisable to feed thyroid in puerperal insanity, and in the insanity occurring at the menopause. The quality of the thyroid preparation should always be beyond question. Parathyroids in Physiology and Therapeutics. — Dr. James J. Walsh purchase singulair online said it was not long after the discovery of the importance of the thyroid gland, and the consequent widespread interest and careful investigation of it, before it was noticed that there were certain small glandular bodies situated in the neighborhood of the thyroid gland, but readily distinguishable from it in histological structure. These were four or five, at times six in number, usually situated at the lower and outer boundary of the thyroid, two or more on each side, but occasionally occupying a place in the midst of the thyroid substance. They were commonly so closely related to the thyroid gland by anatom- ical position that it was practically impossible to remove the thyroid without also removing these parathyroids, or at least injuring them so severely as to obliterate their func- tion. After reviewing the work done by Gley, Munk, Mac- Callum, and others in connection with the parathyroids, and the use of parathyroid material in exophthalmic goiter and Parkinson's disease, the speaker said there seemed levocetirizine montelukast to be no doubt that these little glands in the neck were extremely important, and had a significance very different from that of the thyroid gland. It was possible that they might form an important addition or corrective to the secretion of the thyroid. In the near future, very probably, the physiologist would teach us more about them, and then there might be further questions of their therapeutic use. In the meantime they constituted an interesting field for speculation, and doubtless the powdered gland would be used empirically for other diseases with reported good results. Of course a careful analysis of those results would have to be made in order to determine the true significance of the experimental work done. Physiological Action and Uses of Adrenal Extractives. — Dr. C. E. DE M. Sajous of Philadelphia, in his paper on this subject, said the fundamental importance of oxygen in all the functions of the organism, and in the life process itself, hardly needed to be emphasized; and yet the manner in which this gas entered our blood, and its role in the tissues might be said to be unknown. The prevailing idea was that the entrance of oxygen into the blood, and the elimination of carbon dioxide, occurred in accordance with the physical laws of diffusion of gases, but a well-known English physiologist. Dr. Pembrey, in an impartial review of the subject published this year, stated that it was im- possible to give a satisfactory account of the causes of gaseous exchange between the blood and the alveolar air. Landois, in the last edition of his text-book, ascribed the absorption of oxygen to a chemical process, and adduced various facts which showed that it did not depend on a diffusion of the two gases involved. What was the nature of this chemical process? Bohr and other investigators showed that, contrary to buy singulair the prevailing view, the oxygen Nov. 17, 1906] MEDICAL RECORD. 801 tension was not greatest in the alveoli, but in the arterial blood, and that pulmonary respiration could only be ac- counted for by the presence of "a kind of internal secre- tion," derived perhaps from the alveolar membrane, and capable of actively taking up the oxygen of the alveolar air. The main feature of Bohr's theory, namely, singulair online the source and identity of the internal secretion which absorbed the o.xygen of the air, had failed to come to light, and it was this func- tion which, in a work published in cheap singulair January, 1903, Dr. Sajous ascribed to the secretion of the adrenals — a conclusion which additional researches had sustained. After briefly outlining a few of the facts upon which this conclusion was based, Dr. Sajous referred to the fact that in his work on "Internal Secretions" he ascribed glycosuria to overactivity of the adrenals, tlie excessive oxidation in all tissues causing an increase in the production of singulair cost the agent which converted glycogen into sugar. Another action of adrenal extractives which his views seemed to him to elucidate was the produc- tion of arteriosclerosis by their prolonged use, as recently shown by Josue, Erb, von Rzcntkowski, and others. Shock was another condition in which adrenal extractives promi- nently showed their influence on metabolism. Applying this general principle to the internal use of adrenal ex- tractives, a salient feature asserted itself, namely, that whenever they had been found useful in a general disorder it had invariably been in some condition attended with or due to lowered metabolic activity, or adynamia. Solo- mon Solis-Cohen had introduced the use of suprarenalin in asthma, in cases attended with lowered vasomotor tone, and others had confirmed his observations. The relation- ship of asthma with the gouty diathesis was well known, and it was also known that this condition was an indi- cation of imperfect nuclein catabolism. Migraine was also related to gout, and Thoma and others had reported cases in which relief followed the use of some adrenal extractive. Hay fever, another disorder ascribed to h gouty diathesis, had been found by Cohen to be influ- enced favorably by suprarenalin, allowed to dissolve on the tongue. Adrenal extract had been found of value in neurasthenia by many obser\'ers. including Iluchard. In cardiac disorders it had been highly recommended by sev- eral clinicians. Mankowsky specified that the most use- ful application of adrenal extract was in cardiac weak- ness and threatening collapse. Floersheim found it effec- tive when our usual remedies had failed. Decks ob- tained not only marked improvement in cardiac weakness, but disappearance of attending edema. Boy-Teissier ob- tained excellent results in cases of weak heart, with gen- eral cyanosis and great cardiac dilatation. Finally, in Ad- dison's disease, the vitality was so reduced that we should have in adrenal extract an infallible specific. Some clini- cians had obtained marked benefit from its use; others had observed no effect. Organotherapy from a European Point of View. — Dr. Arnold Lor.xnu of Carlsbad, Austria, took singulair price up tliis phase of the subject. He said that many of the actions of the thyroid could be explained by their iodine constituent. Milk also contained the internal secretions of the different ductless glands, including the thyroid, and thus iodine en- tered into the composition of milk. The iodine was con- tained in the colloid substance of the thyroid, and as the thyroid of the infant was very poor in colloid substance the child received the iodine from the mother. Thyroid treat- ment, with small doses, was harmless, even after the pro- longed use of the extracts, providing these were obtained from the fresh glands of healthy animals, not too old, and providing also that the patient was not taking too much meat at the same time. The experiments of Breisacher

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