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should be taken: i, the removal of focal infections; 2, the relief of psychic irritation; 3, surgical inter- vention. One or both of the first two suggestions CORCIA: PAPILLARY CVSTADENO.VA OF THE OVARY. 457 may suffice. The operation should be a bilateral lobectomy. Much good is done by the various specialists and many cases arrested, since nowadays steps one and two are combined with various local treatments. Vagotonic disorders aside from their cause are alleviated by local palliatives in many cases. This can he noted in the reports of gastro- enterologists, gynecologists, laryngologists, etc. The discussion is not complete without a word as to prophylactic treatment. First, goitre in children should be prevented. 1 examine 1,500 children a year and I am more firmly convinced than when I made the statement some years ago that goitre is largely a result of deciduous dental sepsis. I feel that young girls from five to twelve should be ex- amined yearly and the cephalic extremity kept free of all infections, gingival, otic, tonsillar, adenoid, etc. If a goitre is already present the transit of the girl through puberty demands protection. The demands upon the thyroid by the processes of sexual maturation Mesterolone Tablets are heavy enough without the added irritation of the myriad of physical, mental, and psychic adjustments which arise at this time. During the period of adolescence the appearance of pseudochorea, palpitation and fainting, nervous breakdowns, asthenopia with intractable headache and other nervous phenomena should call for an estimation of the thyroid activity. Especial care should be exercised to keep the body free from focal infection, especially around the Buy Mesterolone teeth, during pregnancy. The physiological activity of the thyroid of pregnancy ceases normally during lactation, but it may be extended by infec- tion or by the influence of anxiety beyond this period. The condition of the thyroid after child bearing merits observation. Another age period marked by thyroid vulnerability is at the meno- pause ; very many stormy changes of life are thyre- ogenic and not ovarian. REFERENCES. I. E. C. Kendall: Experimental Hyperthyroidism, Journal A. Af. A.. 191 7, Ixix, 612. 2. E. H. Reede: Tile New Status of Exoph- thalmic Goitre, Medical Record, March 17. 1917. 3. Louis B. Wilson: The Pathology of the Thyroid Gland in Exophthalmic Goitre, American Journal of the Medical Sciences, 1913, cxivi, 781. 4- I.ouis B. Wilson: A Stv.dy of the Pathology of the Thyroids from Cases of Toxic Nonexophthalmic Goitre, Americafi Journal of the Medical Sciences, 1914. cxlvii, 344. 5. Louis B. Wilson and Generic Mesterolone E. C. Kendall: The Relationship of the Pathological Histology and the Iodine Compounds of the Human Thyroid, American Journal of the Medical Sciences. 1916. cli, 79. 6.' E. H. Reede: The Relation of Mouth Infection to Goitre, IVashington Medical Annals. ini6. xv. 23,1. 7. C. E. Buroet: Attempts to Produce Experimental Thyroid Myperplnsia. Americay. Journal of Physiology, 1917, xliv, 492. 8. D. Marine and O. P. Kimball: Journal of Laboratory and Clinical Medicine, 191 7, iii, 40, Prevention of Simple Goitre in Man. 9. D. Marine and C. H. Lenhabt: Observations and ExperiniL-n's on thr So Called Thvroi.l Carciiviraa of Brook Trout and Its Relation to Ordinary Goitre. Journal of Experimental Medicine, 1910, xii, 311. 10. G. E. Smith: Fetal Athvreosis: A Study of the Iodine Requirements of the Pregnant Cow, Journal of Biology and Chem- istry, 1917. xxi^, .M5. Ti. E, P. Hart and H. Steenbock: Thyroid Hyperplasia and the Relation of Iodine to the Hairless Pig Mesterolone Online Malady. Journal of Biology and Chemistry. 19:8. xxxiii, 313. 12. H. S. Plum- mer: Blood Pressure and Thyrotoxicosis, Transactions of the Asso- ciation of An:crican Fhvsicians, 191s, xxx, 4=;o. 13. E. B. Krumb- haar: Electrocardiographic Observations in Toxic Goitre, American Journal of the Medical Sciences, 1018, civ, 17.;. 14. D. Symmers: The Relationship of the So Called Idiopathic Cardiopathy to Exoph- thalmic Goitre. Archi-.rs of Inlcy.ml Medicine. 191S. xxi. 3!7. 15. W. M. EnoTnBv: The Clinical Value ,.f Metabolic Studies of Thyroid Cases, Boston Medical and Surgical Journal. 1916, clxxv. 564. 16. J. M. BL\CKK.)Rn a..a F. A. Willius: Chronic Heart Block, American Journal of the Medical Sciences, 1917, cliv. 58s. 17. L. Barker: Discussion of Treatn'ent of Neurasthenia, Johns Hopkins Hospital Bnllplin. iot6, xxvi. 2S8. 18. E. Goetsch: Func- tional Significance of Mitochondria in Toxic Thyroid Asenomata, Johns Hopkins Hospital Bulletin. 1916, xxvii. 129. 19. Reid Hunt: Vasodilator Reactions, American Jonrnal of Phvsiology, 1918. xlv, '97- PAPILLARY CYSTADENOMA OF THE OVARY.* With Report of a Case. Bv John Corcia, M. D., New York.

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