186 THE INTERNAL SECRETIONS—1920 
lent results from long-continued use of small doses of 
thyroid with or without other synergistic endocrine 
remedies. 
Type 3. The adrenal type of malnutrition includes 
those emaciated, pale, tired-out children, who always 
have circulatory inefficiency with cold hands and feet. 
Their muscles are flabby, blood pressure is low, the ap- 
petite carpricious, and mentality sluggish. Indolence 
and disinterestedness is usual, and the generally low re- 
sistance, marked asthenia and poor elimination of 
waste products ofttimes is associated with a nephritis. 
In this class I get the best results from applying the 
principles of adrenal support so thoroughly emphasized 
by Harrower, plus, of course, proper care of the emunc- 
tories, well-enforced rest, and good food. 
Type 4. Certain children, of what might be called a 
hyperadrenal type, show signs of sympathetic stimula- 
tion, rapid heart action, unstable digestion, with fre- 
quent gastric disturbances, and dilated pupils. The 
skin is soft, moist, and there is a tendency to hyper- 
trichosis. They are often emaciated and anemic, but 
many of them tend toward an excessive development 
of the body and ossification of the bones, and they ap- 
pear tall, thin, and delicate. Often they are especially 
predisposed to infection. In these cases anti-adrenal 
measures give the best results, and since the pancreas 
opposes the adrenals, combinations containing this 
preparation are sometimes marvelous in their effects. 
Type 5. In many cases of so-called chronic consti- 
pation in children, a more careful examination will 
reveal other symptoms, which point to a condition of 
hypothyroidism. These symptoms include a tendency 
to obesity, laziness, fatigue, somnolence and anorexia. 
There is a retardation of certain developmental pro- 
cesses as dentition, walking and speech. Muscular and 
arthritic pains are usual, and frontal and occipital 
headache is common. Apathy, indolence, depression 
