ENDOCRINOLOGY IN PEDIATRICS 185 
Type 1. Marasmic cases seen in infancy have been 
shown to be associated with an abnormally early 
atrophy of the thymus gland. In treating these cases 
all attempts at drugs, wet-nursing and artificial infant- 
feeding often failed. Within the past three years I 
have been giving thymus gland with small doses (gr. 
1/8) of thyroid with excellent results. This treatment 
I keep up for several months, with intervals of ten days 
every six weeks. In the milder forms of infantile 
atrophy, resembling rickets, the little patients fare bet- 
ter with a pluriglandular combination of the above 
with lymphatic gland, such treatment favoring the 
mineral metabolism and lymphatic circulation as well 
as the cellular oxidation, which it will be recalled, is 
largely controlled by the thyroid gland. 
Type 2. Rachitis, or impaired nutrition, with alter- 
ations in the growing bones of children, sometimes lat- 
ent up to the ninth or twelfth month, is due to calcium, 
phosphorous or mineral metabolic disturbances. Asso- 
ciated with this we have sluggish lymphatic activity, 
retention of the cellular toxins and often a resultant 
hypoadrenia. With this frequently one finds an asso- 
ciated hypothyroidism and dyspituitarism as evidenced 
by the low blood pressure, tendency to dwarfism, mus- 
cular and arthritic pains, sluggish mentality, soft and 
flabby tissues—especially the skin, which sometimes 
resembles myxedema; muscular weakness and various 
abnormal changes of the bones and cartilage with lack 
of calcium deposition. In these cases it is well to note 
also the close relationship of rickets to hypoparathy- 
roidism since these children often suffer from infantile 
convulsions, tetany and laryngysmus stridulus, which 
class of disorders are akin to the convulsive type of 
difficulties which have been definitely connected with 
parathyroid insufficiency. As a result of these condi- 
tions in these cases we sometimes find an enlarged 
spleen, liver and lympathics. In such cases I get excel- 
