188 THE INTERNAL SECRETIONS—1920 
ovary), has given me quite the best results in these 
cases. Lymphatic gland therapy sometimes is an ad- 
vantage and thyroidectin with quinine hydrobromate 
are also synergistic. In those who suffer from marked 
thyrotoxicosis with exophthalmos and degenerative 
changes of the heart, I advise surgery. [Thyroid sur- 
gery must be avoided wherever possible in children and 
youths.—H. R. H.] 
Type 7. A certain class suffer from irregular con- 
stitutional symptoms which are connected with dis- 
turbed elimination. There is a tendency towards so- 
called gouty conditions and the uric acid diathesis. 
Joint conditions are common, and deposits of sodium 
biurate in or about the joints may bring about serious 
deformities. With this may be found polyuria and nu- 
tritional disorders, which point to a functional disturb- 
ance of the pituitary body, which is supposed to control 
the metabolism of the purin bodies, and has been defi- 
nitely connected with the etiology of diabetes insipidus. 
A close study of these children occasionally will dis- 
close slight evidences of the changes in the features ex- 
pected in acromegaly. The treatment of these cases 
involves the use of thyroid and pituitary extracts, and 
the results are sometimes very good, especially when 
the diet is regulated in regard to its purin content and 
special efforts are directed to the regulation of the 
emunctories. 
Type 8. The lymphatic type. Many children suffer 
from nutritional disorders with or without anemia, in 
which the liver, spleen, and lymphatic glands are defi- 
nitely involved. These children appear undernourished, 
underfed and phlegmatic. They often puff up at the 
least exertion and breathe like asthmatics; they may 
indeed have well-defined attacks of asthma. They are 
particularly subject to blood and lymphatic dyscrasias. 
They bleed easily, may show petechial areas in different 
parts of the body or give a history of a disturbed coag- 
