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Why Club a Cough

or attempt to overcome bronchial irritation and inflammation by outraging the stomach with nauseous expectorants or "Knock down" narcotics? Oil taken into the stomach, reflexly stimulates bronchial secretion, relieves congestion, soothes cough, does not disturb digestion, nor mask other symptoms.

Terraline

(Petroleum Perification)

is medicinally pure petroleum oil, palatable, without action upon digestion and prompt in its influence upon the respiratory tract. It soothes cough and subdues irritation.

TERRALINE is also mildly laxative, when used as an intestinal lubricant. It is an ideal vehicle for many medicinal agents. It is intended for physicians prescribing only, and for the convenience of the physician is put up Plain, with Heroin, or with Creosotes.

In spite of the use of arrhenic compounds authorities advise the "follow up" treatment with mercury and often iodide in luetic conditions.

PIL MIXED TREATMENT (CHICHESTER) is a perfectly baldependable formula containing mercury and KI, well tolerated, active and efficient.

Sold in bottles only-never in bulk. Price $1.00 per bottle.

Hillside Chemical Co.

NEWBURGH, N. Y., U. S. A.

Vol. XXXIX.

Continuing the Medical Fortnightly and Laboratory News

The Medical Herald

and Electro - Therapist

=

Incorporating

The Kansas City Medical Index-Lancet

Original Contributions

An Independent Monthly Magazine

JANUARY 15, 1920

[EXCLUSIVELY FOR THE MEDICAL HERALD.]

THYROID RESPONSE TO OVERSTRAIN* GEORGE H. HOXIE, M. D., Kansas City, Mo. 1. The Cause of Thyroid Dysfunction-For the last generation the function of the thyroid has been popularly considered that of the detoxicator par excellence of the body. Therefore the invasion of infectious agents and the absorption of toxins (as from drinking water) have been considered the exciting causes of reactive (compensatory) thyroid enlargement of hypofunction, or even of hyperthyroidism.

Later, as the complexity of the endocrine balance began to be appreciated, compensatory hyperplasia and hypertrophy because of the activity of the sex glands was spoken of. Thus the goitres of puberty and pregnancy were regarded as compensatory.

Then after Cannon's study of the adrenals and their antagonism to the thyroid, an added conception of endocrine reaction entered.

Thus Cannon attributed hyperthyroidism to the lowering of the threshold of thyroid activity brought on by exaggerated function- by increased discharge into the bloodstream of the adrenals. Since this result could occur from excessive emotionalism and nervous overstrain, the theory fitted in well with the facts of every day observation. Then the matter of fatigue, as emphasized by Rogers (Archives Int. Med., 1919; 23:498), showed that both the adrenals. and the thyroid might be involved, in an attempt to compensate for the exhaustion of the end plates in cases of prolonged exertion, as well as from debilitating disease.

2. Exophthalmic Goitre and Thyroid Hyperfunction-The matter of endemic goitre has received some illuminations from the work of Kerr in his studies of the recruits of the northwestern

Read before the Medical Society of the Missouri Valley at Des Moines, Iowa, Sept. 18, 1919.

No. 1

states. He confirms the opinion that goitre is more common in Washington and Oregon than in the neighboring states. He shows, too, that this type of goitre enters only casually into the matter of neurocirculatory asthenia. On the other hand, Wearn and Sturgis (Archives Int. Med., 1919:24:247) show that a large majority of the recruits suffering from NCA respond to the adrenalin test of Goetsch for thyroid hyperfunction. Hence a distinction must be made between thyroid hyperplasia and thyroid hyperfunction.

Janney (Arch. Int. Med., 1918:22:187) has shown that all cases of exophthalmic goitre are not cases of thyroid hyperfunction. And the now well known fact that the thymus is frequently (60 per cent) enlarged in exophthalmic goitre, makes it necessary to revise our nomenclature and make a new definition of this disease.

3. Observations in France-In France, last year, many cases of thyroid enlargement and thyroid hyperfunction appeared among the soldiers as the secondary reaction to exhaustion, and to the debilitation resulting from disease. confirms the theory that thyroid hyperfunction may be a compensatory phenomenon.

This

The sequence of events in these cases was somewhat as follows: The patient entered the hospital with a blood pressure of 70 diastolic and 90 to 100 systolic. The heart action was not clear and sharp. That is, one heard systolic murmurs at the second and third left interspace. The blood and urine were usually negative. The breath sounds were usually harsh, and there was frequently the evidence of enlargement of the peribronchial lymph glands.

The blood pressure gradually rose until in three or four weeks the diastolic might be 100 and the systolic 160. With this there was urinary frequency and nocturia but no albuminuria. The pulse showed a constant tendency to tachycardia. A tremor of the fingers would then appear. There was generally an increase in the size of the thyroid. In the majority of cases there was an intermittent diarrhea, a tendency to sweating was marked; and frequent rises in temperature were noted.

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