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laise and the pains in the knees and calves of the leg, with severe headache, entirely disappeared. The urea output, which had been uniformly subnormal, became normal, and tachycardia, present in over 60 per cent. of the patients, was diminished. For the postoperative symptoms, such as severe constipation and continued vomiting, after such procedures as gastroenterostomy and jejunostomy secretin had proved of distinct value, and in viagra patent expiry uk nephritis of intestinal origin it was one of our most efficient therapeutic agents. Although in the way viagra patent expiry uk of clearing up indicanuria he did not believe it had such a direct beneficial influence as the culture viagra hong kong pharmacy of the Bacillus bulgarims, through its action in stimu- lating peristalsis and assisting the complete digestion of protein it aided materially in ultimately overcom- ing intestinal putrefaction more thoroughly and per- manently than could be effected by any other means. Eventually, also, the albumin disappeared viagra hong kong pharmacy from the urine. If secretin were prepared as it should be, there could be no question that distinct results would viagra hong kong pharmacy follow its administration by the mouth; but in standardizing this substance it was necessary that considerable care should be used in its preparation. For its artificial production the duodenum of the pig was preferable to that of other animals because of the varied character of the food eaten by the pig. The process employed by Dr. Beveridge was different from that advocated by Starling. After the duodenal mucosa had been scraped and cleaned it was macerated, and a small quantity of hydrochloric acid added. It was then heated in a beaker or other suitable vessel for from three to five hours and completely digested, the temperature never b€ing permitted to rise above 210' F. During the process of heating from 1 to 2 per cent, of the salts of the blood serum were added, and finally, after filter- ing, sufficient glycerin and alcohol to preserve the preparation. Ordinarily secretin was an unstable, readily oxidizable product, and unless it was viagra patent expiry uk fi.xed in some way its activity was viagra patent expiry uk quickly lost. Furthermore, he had found that if secretin alone was injected into the blood-stream, no pancreatic secretory excitatioi) occurred, and the same negative result followed the similar injection of an acid, of blood serum salts, or of Locke's physiological solution; but if secretin were thus injected in combination with serum salts or the Locke solution, there was noted an immediate response in the secretory activity of the pancreas. The same result was observed in the oral administration of secretin, and the addition to it of blood serum salts was therefore essential. By way of summary it might be said: (1) Secretin is indicated in all pancreatic insufficiencies in which true organic changes have not occurred. (2) It may be employed to advantage in secondarily aiding protein digestion. (3) It consti- tutes the most important factor in causing a low urea output to rise to normal. (4) It has no power to aid in the digestion or breaking down of the carbohydrate molecule. (5) It is indicated in gastroenterostomy and jejunostomy. (6) It is of distinct value in nephritis of intestinal origin. (7) It increases peristalsis and is indicated in all cases of intestinal stasis. Dr. William Van Valzah Hayes said that up to the present there had been some uncertainty regarding the action of secretin because it had not been suffi- ciently standardized. Personally, his practical experi- ence with it had not been large on this account, and he was very glad to have the definite information on the subject given by Dr. Beveridge. If we had an entirely reliable preparation which could be admin- istered by the mouth it would undoubtedly be a very valuable addition to our therapeutic resources. In some cases he had observed secretin had appeared to do wonders. As to its action in the stomach he would like to ask Dr. Beveridge how it affected the gastric secretion — did it increase the hyperacidity? If by means of it we could increase a low urea output it would certainly be a great gain. The medical profes- sion, he thought, had not yet availed itself of the great possibilities of this agent viagra hong kong pharmacy because there had been no standardized, dependable preparation for general use, and it was to be hoped that the expense of such a preparation would not be prohibitive. Dr. RoLFE KiNGSLEY Said that nearly all those using secretin had, because of its having a characteristic action, employed it in the treatment of diabetes, but it had been found to have no effect on the sugar in the urine. It viagra hong kong pharmacy was observed, however, that diabetics taking it gained in weight and were greatly improved in gen- eral health. This was now explained by Dr. Beveridge, who had shown the favorable action of secretin on pro- tein metabolim and its effect in relieving intestinal stasis. Some years ago this agent was employed in about thirty cases of diabetes at the Vanderbilt Clinic, under the supposition viagra patent expiry uk that in its action on the pan- creas was included an effect on the islands of Langer- hans, but the results observed were entirely disappoint- ing. Dr. Beveridge had stated that in the preparation of secretin it was essential that the boiling point should be avoided, but it was a fact that the secretin used at the clinic had been boiled for four hours. Dr. Henry R. Harrower. having urged the need viagra patent expiry uk for viagra patent expiry uk a more extended con.sideration by the profession of the therapeutic possibilities of secretin, said he recalled some experiences in the treatment of conditions asso- ciated with low total solids in which the urea output was materially increased after a course of buttermilk given several times a day, and it seemed to him very likely that the lactic acid acted in the same way as the normal gastric acid, by releasing prosecretin from the duodenal mucosa and thus stimulating the whole, digestive process. An important field for the use of 508 MEDICAL RECORD. [September 18, 1915 secretin preparations was in the digestive disturbances