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and not the man himself, must make the choice. He had only to be willing to accept the decision of the L'lOvernment, unless he wished to be classed with the pacifists and the disloyal. A man should enroll in the Medical Reserve Corps or with the Volunteer Reserve Corps. The Question of Operation in Abdominal Gun- shot Injuries. — Dr. J. R. Eastman, of Indianapo- lis, began by saying that at the beginning of the war, two schools of surgery existed in the armies of the belligerents — the abstentionists and the in- terventionists ; the first had to wait to make a diag- nosis, the second made the diagnosis by laparotomy. The course of the missile in gunshot wounds was often difficult to determine. Generally speaking, the closer the wounds of entrance and exit, the less danger was there of perforation. A missile even occasionally passed out through the rectum without perforating. Protrusion of Levitra Generico 40 Mg the bowel indicated perforation, the symptoms of which were pain, vom- iting, costal breathing, shock, retraction of the tes- ticle, meteorism, tympanites, and intraabdominal hemorrhage. The class of wound depended to a great extent on the type of missile, the smooth bullet producing little laceration, but great damage being done by larger shell fragments. Shrapnel bullets tended to remain imbedded in the abdom- inal coverings and did comparatively little visceral laceration. The time of transportation of the wounded had direct relationship to operability, the mortality increasing with each hour of delay in transport. In small, nonpenetrating wounds con- servatism was Indicated. Records since the begin- June 2g, 191&.] ANNUAL MEETING OF THE AMERICAN MEDICAL ASSOCIATION. 1 24 1 ning of the war showed that the interventionists had a record of fifty-nine per cent, mortality, as against seventy-seven per cent, among the absten- tionisls. 'i'he deaths after intervention occurred at once ; those after abstention occurred in later stages, from fistula, etc. In nonoi)erative cases, the patient was put to bed with shoulders raised and knees flexed. Opium was given to control pain. Shock was combated by injection of normal salt solution. Stomach wounds showed certain peculiarities. In Levitra Generico 40 Mg perfora- tions of the anterior wall there was no outpouring of the gastric contents into the lesser p)critoncal cavity ; the contrary was the case with wounds of the ])osterior wall. This was due to some peculiar- ity of visceral hydrostatics. In gunshot wounds of tlie liver, the hemorrhage was often found to sub- side spontaneously. Occasionally associated in- juries of the thorax and abdomen occurred. Men had been known to cough up a bullet from an ab- dominal injury by way of the lung. Multiple in- juries of the chest and abdomen were also encoun- tered. SECTION IN SURGERY, GENERAL AND ABDOMINAL. The Principles of Thyroid Surgery. — Dr. C. H. .\l.\Mi, of J\ochestcr, Minn., in his address on this subject, said the thyroid was undoubtedly one of the most important glands in the body, and while we were far from a complete knowledge of Levitra Generico 40 Mg its activi- ties, the work of Plummer and Kendall, through investigations into the jihysiologic action of its se- cretion, was such as to bring us to the verge of a realization of its fundamental ciTcct on life. Ken- dall had been able to separate the compound of the thyroid containing iodin from the balance of the gland, acconii)lishing this by destroying the proteins of the tiiyroid by means of boiling with a strong alkali, which did r.ot decompose the iodin containing compound, and, by suitable treatment, could be sep- arated as a pure crystalline substance containing sixty-five per cent, of iodin, its formula being C'lilIioCjNi.,. The compound contained an organic nucleus called indol, as well as oxygen. Levitra Generico 40 Mg Investi- gation of the activity of the gkuul showed the iodin to be not directly involved in the functionating of the substance. 1 nt mcrelv increasing its jjower to react. Plummer, from a clinical standpoint, resulting from observation of many thousands of cases of goitre, numerous cases of cretins and of myxedema- tous jiaticnts, had shown that the rate at which energy was produced by the animal Levitra Generico 40 Mg organism was controlled by the amount of thyroxin acting within tlie cells of that body. While not the only factor Levitra Generico 40 Mg infiuencing the rate at which we lived, it probably had more to do than any other substance with the govcrniiinf of the sjiecd at whicli energy was pro- duced in the body. Plummer showed the average Levitra Generico 40 Mg l)asal niclaholic rate of exophthalmic goitre patients at the time of coming under observation to be fifty- two per cent, above normal, and the average rate in those in whom ligations were done and who re- turned in three months, to be iilus thirty-nine per cent. The average metabolic rate eighteen days aflcr thvroidectomy was plus nineteen. Ligation probably caused the metabolic rate to drop approxi- mately twenty per cent. Other factors being con- stant, the total energy output of the body varied with the amount of thyroxin in Levitra Generico 40 Mg the tissues and the rate of excitation. In persons under twenty-five years of age, small adenomas in the thyroid, and the simple colloid Levitra Generico 40 Mg goitres were only occasionally recommended for surgery. Later in life, the degenerations which occurred in goitres of long standing such as en- capsulated adenomas and encapsulated colloid areas when the Levitra Generico 40 Mg secretion has become reduced, might de- velop thyrotoxic conditions. SECTION IN ORTHOPEDIC SURGERY. Recent Studies in the Anatomy and Physiology of Tendons: Operations. — \)r. Lko Mevek said his interest in tendons was first awakened in Levitra Generico 40 Mg the