ENDOCRINOLOGY IN PEDIATRICS 187 
and mental retardation make a picture that may be 
indeed pathetic. Not infrequently there is also an im- 
perfect development of the sexual organs and functions. 
Thyroid therapy gives excellent results in such cases, 
though the treatment must be long-continued and the 
dose increased from time to time, carefully watching 
for symptoms of thyrotoxicosis, such as tachycardia, 
insomnia, headache, pain in the back and limbs, trem- 
bling and prostration—at the slightest evidence of 
which the dose should be promptly reduced. 
Type 6. Malnutrition, accompanied by hyperthy- 
roidism, occurs usually in older children, beyond 
puberty, and the difficulties may begin at that time. 
Exophthalmos may be associated with this condition, 
but it is rare. These individuals usually are tall, thin, 
and high-strung. They appear anemic and manifest 
many of the symptoms that one finds with hyperadrenia 
(Type 4). They are very temperamental and excitable 
and some of them exhibit a tendency towards precocity 
or even genius. The influence of hypercrinism upon 
the vegetative system brings about the symptom-com- 
plex known as sympatheticotonus. Cardiovascular dis- 
turbances are the rule, tachycardia is common, and fre- 
quently bounding arterial pulsations in different parts 
of the body are noted on examination and are sometimes 
an annoyance to the patient. The skin is moist and 
periodical vasodilation occurs very easily. These indi- 
viduals blush easily. Hypertrichosis is occasionally 
found, and it is remarkable how frequently urticaria or 
similar dermatoses are found. The large, brilliant, oft- 
times slightly protruding eyes are rarely associated 
with exophthalmos and conditions of this kind may be 
easily mistaken for multiple sclerosis. They also may 
suffer from such neuropsychic conditions as migraine, 
neuritis and mental disorders. The use of the adrenal 
sympathetic sedative formula, originated by André 
Crotti of Columbus (pancreas, adrenal, pituitary, and 
