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In this case no treatment was directed to the thyroid per se. The tonsils were removed, four infected wisdom teeth were extracted, the work, the study, and the physical exercise were standardized, and his sexual knowledge was revised and amplified. Two months after operation the blood pressure 'S 130-60. heart rate 72, and the general con- dition indicates a parallel and progressive betterment. The chronic coryza is absent. The thyroid is diffusely enlarged and of colloid consistence. The stage of fixed hypertension is quite identical in symptoms with the condition to which Janeway gave the name of primary hypertensive cardiovascu- lar disease with the added feature of a goitre. There is generally present a more or less progressive in- fection Buy Lovegra Online and often psychic factors of undeniably irritative import. Alild Cheap Lovegra vagotonic symptoms appear after periods of definitely [)rodigal energy expendi- ture. Case 365. — Constantly toxic high pressure goitre, stage of fixed hypertension, cardiac hypertrophy, hypertension, 180-115. Heart rate 88, sinus infection, frontal. Dental sepsis consisting of gingivitis under crowns and bridges and periapical infection. Service of Dr. Lovegra Online Mead Moore. Dental examination and radiography by Doctor Sharp. Woman, age forty. This lady recently detected an asym- metry of the neck which has since caused some annoyance because of the cosmetic defect. Lovegra For Women She is a cultured student, a teacher of languages, always very active, and noted among her friends for alertness of mind and energy of body. This patient suffered from rheumatism at the age of eleven, was ill four months; at seventeen the tonsils were removed: at twenty-five again had Generic Lovegra rheumatism, after a Lovegra 100mg stillborn chdd; at Lovegra Tablets the age of thirty-seven a third attack of rheumatism was definitely ascribed to her teetli, and she was treated for pyorrliea. Eighteen months ago con- tracted a frontal sinus infection in the attention to which she has been ddatory and which still shows some indica- tions of irritability. She reacted to vaccine therapy with marked serum sickness. One year ago Buy Lovegra she undertook the reliabilitation of a rundown private school, an undertaking fraught with much physical and psychic strain : one montli hiter she developed an attack of pityriasis. She has no complaint to make of her liealth, feels bettemthan ever before in her life, and often wonders at her own tirelessness. She believes that ill health is largely a matter of auto- suggestion and lives accordingly. She keeps her weight down by doing 100 bending exercises daily. This lady is unwilling to accept any Lovegra Price suggestion for treatment. The focal infection is undoubtedly in the mouth, the psychic factor presumably in her overwork. Considering that this lady's father died at sixty-four of paralysis, and the mother at sixty, of angina, the prognosis is not bright. The thyroid is diffusely enlarged and shows in addition a lime sized adenoma in the right lobe. The stage of cardiovascular degeneration is a picture of arteriosclerosis and myocarditis with their appropriate syinbolism plus an asthenia, a pigmentation of the skin, and Lovegra Uk a slowing, both mental and motor, that suggests Addison's disease. A vascular nephritis adds an albuminuria which often deludes the observer. The thyroid is often far spent at this time and may welcome artificial as- sistance. It is the efficacy of small doses of thyroid powder in analogous cases which has originated the fallacy that thyroid medication is beneficial in ne- phritis. Boothby cites a pseudonejihritis in which albumin and casts cleared and the functional tests improved (15). A partial lieart block in this type of case improves under thyroid medication. In a personal communication dated December 2, IQ15, Dr. R. G. Hoskins, of Northwestern, whose experimental knowledge of the suprarenals is not excelled in this country, queries, "In cases of long standing hyperthyroidism could not the asthenia be best explained as due to over stimulation of the suprarenals leading to final atrophy?" Case 147. — Male, age seventy-two. civil engineer. Serv- ice of Doctor Balloch. Relief was sought in this case for extreme and incapacitating shortness of breath associated with numbness of the legs after walking much. This con- dition had been progressive during the last two months, following an exhaustion in the field, since which time he has been at a desk. This man has led a most active and most interesting life in his duties as government engineer, particularly in the building of lighthouses such as Hopkin- son Smith idealized, and with whom he was associated. His life story is one of unending tirelessness, endurance and optimism He has never been sick. Upon examination one is impressed by the extreme breathlessness and by the irregularity of the heart. The heart extends to the axilla, is irregular in force and rhythm Siiitcmber 14, 191S.] REEDE: TOXIC NONEXOPHTHALMIC GOITRE.

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