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stimulation. Inactivity or insufficiency of these glands is associated with signs of sympathetic nerve depression. The children of great energj' exores- sion who later become the adults envied by their business associates because of their "pep," are probably endowed not only with sympathetics of superior quality, but also with ductless glands capable of superior mobilization. I doubt that the thyroid secretion has any direct toxic influence upon either of thpse nerves. The influence of the thyroid obtains either through its indirect effect through metabolic variations in the nerve tissue or through metabolites produced in the course of thyreogenic metabolism. Injection of the lopressor 50 mg active principle of the thyroid into the blood Cheap Lopressor stream elicits no effect before a period of about thirty hours, nor does this injec- tion, as Levy shows, have any immediate influence on the cardiac vagus nerves. This corresponds closely with Lopressor Xl the massive intoxication occurring on the second day after thyroidectomy. The nara- s\nnpathetic and sympathetic nerves are theoreti- •Rri'l Before the WnshingtoTi Medical Society, May 29. 1918. cally in balance, but this poise is seldom found in lopressor price practice. Many children are readily assigned to one or other of these divisions. If a sympatheticotonic child develops lopressor 50mg an lopressor 12.5 active goitre it becomes lopressor hct more sympatheticotonic ; if a vagotonic child develops an active goitre it becomes more vagotonic. The in- creased function following the metabolic accelera- tion produced by thyroid was greater in the tissue which was naturally stronger. Recent work by Kendall suggests that the sympathetic stimulation is lopressor 50 not only a suprarenal stimulation but that the active suprarenal produces in the course of protein metab- olism a preurea compound which is also highly stimulative. The absence of the preurea compound, lopressor 25mg i. e., the presence of inactive suprarenals, is accom- panied by depression, and this depression comparable to suprarenal removal is, he thinks, due to the sub- stance which is not spht into preurea. The sympa- thetic depression suggests a result of inactive supra- renals plus the action of a substance stimulative to the parasympathetic system. This experimental depressive Lopressor Online hyperthyroidism is so comparable to depressive hyperthyroidism in man as to merit notice. Kendall's experiment consisted in feeding intra- venously thyroid hormone and aminoacids Lopressor Mg and ob- serving the nitrogen metabolism. Proteins from food are taken into the blood as aminoacids and after accomplishing their purpose are excreted in the urine as Order Lopressor urea. Kendall finds that the work of the thyroid hormone ceases when it has broken the aminoacids up into ammonia compounds. To change lopressor 25 mg the ammonia into urea there is needed a new factor and this factor he finds to be the adrenal cortex, which produces an almost urea substance, the preurea. Aminoacids in the presence of thyroid hormone always break up into ammonia compounds. Whether an excess of ammonia Lopressor 100 Mg or an excess of preurea occurs lopressor 12.5 mg depends upon the rapidity with which the suprarenals act. In the animals thus fed, Kendall was able to produce a symptom gradient the sunmiit of which was represented by an excess of preurea and signs of great stimulation, and the base of which was indicated by extreme prostration and an excess of ammonia in the tissues ; and the decisive factor was the ability of the cortex to reduce ammonia. The obvious fact was that some animals de- veloped an exaggerated metabolism with great stimulation, while other animals with an equally Buy Lopressor Online great excess of circulating thyroid hormone devel- oped a perverted metabolism and signs of depres- sion. An lopressor 25 animal whose one cortex was found to be most inactive after being thoroughly angered furnished from the remaining cortex an example of great activity. Kendall feels justified in making this statement : "'Thyroid activity in Buy Lopressor the absence of a simultaneous suprarenal cortex activity does not produce the usual so called hyperthyroid symptoms but instead a condition of depression." The phe- nomenon which puzzled Kendall was the absence of the well known stimulation signs purchase lopressor of experimental hvperthvroidism in the presence of a known over- secretion and Ihe occurrence of a depression in- stead ; the phenomenon which has puzzled clinicians has been an obviously oversecreting thyroid not pro- September 14, 191S.] REEDE: TOXIC NONEXOPHTHALMIC GOITRE. 453

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