190 THE INTERNAL SECRETIONS—1920 
one’s ability to recognize these abnormalities early, 
when our efforts are more likely to be effective. If, 
when making the physical examination of the child, we 
will note the normal anthropometric data, the normal 
mental status, the tonicity of the muscles, the condition 
of the skin, the size and integrity of the sex organs, the 
condition of the special sense organs and the physical 
signs dependent upon sympathetic, parasympathetic 
and vasculomotor control, we will discern much valua- 
ble information regarding the early stages of pluriglan- 
dular dysfunction. 
To cite an instance: E. S., five years old, was 
brought to my clinic at the Lenox Hill Hospital, com- 
plaining of chronic constipation and headache. The 
mother wandered with her from doctor to doctor, to 
various consultants and institutions, and was told that 
the child had a nervous disorder, due to autointoxica- 
tion from chronic constipation. By careful examina- 
tion of the child I found that she had a dry myxedema- 
tous skin, flabby muscles, muffled speech, stunted 
growth, retarded walking, dentition and mentality. 
This case was typical of hypothyroidism. She im- 
proved under thyroid treatment, her constipation dis- 
appeared without laxatives and her general condition 
was very much better. I can recall many similar exam- 
ples, too numerous to report in this limited paper. 
GROWTH DYSTROPHIES 
In dwarfs, the abnormal physical signs may show 
themselves early. As arule, we find undeveloped mem- 
bers of the body, such as one upper or lower extremity, 
one-half of the face, etc. Parrot, Porak and Marie 
have reported many such cases. Kaufman applied the 
term “chondrodystrophy” to the cases he reported. 
These conditions are caused by thymus and pituitary 
dysfunctions as evidenced by the defective and unequal 
cartilagenous and bone growth. In my ecase of dwarf- 
