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Subsequent pregnancies. Of the series, exclud- ing the cases that ended fatally and those in which the operation j)reclude(l pregnancy, there were four- teen Buy Geodon Online patients whose history in regard to subsequent pregnancies was obtained. Of these fourteen cases, three had subsequent normal pregnancies. One pa- tient had three children, another two children, and the third had a miscarriage. In addition to these cases of normal pregnancy, there were four cases or 8.7 per cent, of subse(|uent extrauterine gestation. 2^2 West Fiftieth Street. SURGICAL TREATMENT OF HYPER- THYROIDISM.* By John B. H.aeberlin, M. D., Chicago. i Iy])erthyroidism was used by the internist and physiologist some ten to twenty years ago to desig- nate an increased secretion of the thyroid gland in contradistinction to hyposecretion, called hypothy- roidism. Its activity was classified, clinically, from an entire absence of secretion through the various grades of diminished secretion past the normal, Buy Ziprasidone Online then to the excess of secretion. As the interrelationship of Generic Ziprasidone the ductless glands and their interdependence one upon the other were more understood, it was noted that quantitative production was but one of the factors of thyroid secretion. The term, hyperthyroidism, unfortunately does not express our present day idea of the symptom complex Order Ziprasidone Online formerly designated under this term. It is a term whose meaning and usage are changing, owing to our modern advances and researches. jMuch better usages are. I believe, thyrotoxicosis, as it expresses the poisoning resultant from the gland or dysthyroidea, which accounts for the perverted secretion which may be altered qualitatively as well as quantitatively. This thyroid toxin is thought by many to be a primary affair, not a secondary or concomitant symptom. The indications for its relief are, i, pre- vention of toxin formation; 2, elimination, or, 3, neutralization. There is no medical means for the j)revention of toxin and no means of elimination. As to neutralization or counteraction, we have an attempt in the form of serums, thyroidectins, rado- gen or milk of thyroidectin goats, etc. The one great thing to do is the destruction or extirpation of the toxin producing parenchyma, and this is done by our surgical methods. The surgical means Purchase Ziprasidone Online are there- fore logical and based on facts and results. The surgical treatment of hyperthyroidism is sim])ly the result of evolution, an effort on the part of the profession to give relief to patients. The internists, after fruitless efforts, have in a measure unloaded their responsibility on the surgeon, and we find that during the past decade the operation for *Read before the Englewood Brancli of the Chicago Medical Society. tliyrotoxicosis has grown from an exceptional pro- cedure, being performed in extremis, to one of com- mon occurrence accepted by most of the American profession as the correct procedure. If we look up operative work on the thyroid gland as it existed twenty years ago, we shall be struck by its Buy Geodon terrific mortality, its tremendous complications occurring early as hemorrhage and shock, and late as tetany, myxedema, voice involvement, etc. This, when compared with our present day surgery on the thyroid, shows our great improvement. At some clinics as many as 275 cases have been operated Purchase Geodon in without a mishap — early or late. There are many factors accountable for this and the one most para- mount is the early diagnosis and operation in our cases. Taken along with our fuller knowledge as to its anatomy, physiology, pathology, and improved technic and surgical skill, this has brought the morr tality and complications to such a plane that it is not met with the fear that once swayed the surgeon. We have in reality an operation which has arisen out of the extreme danger plane. It is distinctly a modern operation and has its greatest impetus in, first, Cheap Geodon the frequent failure of medical treatment, and, second, its own successful results. The operative procedure on the thyroid gland has its greatest backing Purchase Ziprasidone in the American school despite the fact that Kocher is the Nestor of thyroid work. Not all schools by any means are as enthusiastic as the American school. At the Mayo clinic practically all thyrotoxicosis cases are considered as surgical. Plummer (i), in giving his indications for opera- tion, includes cosmetic, prophylaxis, pressure and thyrotoxicosis, practically every condition. Crile (2) says "there is no more doubt in my mind as to the benefits of operation for exophthalmic goitre than for opening an abscess." And this Order Geodon is the trend of the American surgeon in general. Osier jecom- mends operation. Next comes the (iernian school, a little more cautious and conservative. Striimpell (3) remarks, "many surgeons have great confidence in the opera- tive treatment of exophthalmic goitre." He himself is not overenthusiastic. Kocher (4), on Order Ziprasidone the other hand, says "we long ago abandoned the belief that every goitre must first be treated Buy Ziprasidone by internal rem- edies and referred to the surgeon only if internal medication fails." The l^rench school, I believe, is most pessimistic. Dieulafoy (5), after a careful summing up, says, "it is therefore impossible at present to give surgical treatment the preference over medical means." Manv French surgeons are skeptical Buy Cheap Ziprasidone as to the sur- gical results. One can see how conflicting these ideas are. Flowever, some one must be right. Truth will eventually prevail.

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