194 THE INTERNAL SECRETIONS—1920 
phenomena of melancholic type, incident upon puberty, 
are quite noticeable among school girls. Small and long- 
continued doses of thyroid improve the mental condi- 
tion of these children. After a period of two years of 
treatment they enjoy a fair degree of mental health 
and activity. 
In hyperthyroidism, on the other hand, we may find 
the active manias and neurasthenias, sympatheticotonic 
and vagotonic irritability, while, as a result of dyspi- 
tuitarism we see sexual infantilism, apathy, backward- 
ness, lack of ambition and inability to do ordinary 
work. In the former, I get good results from Crotti’s 
pancreas combination, thyroidectin and quinine hydro- 
bromide and in the latter with pituitary preparations. 
In those suffering from ovarian and testicular dis- 
turbances we get sexual perversion, mental disorders, 
erotomania and active or depressed mania. The men- 
strual periods have special bearing upon the metabol- 
ism and mental forces. In these disorders they im- 
prove on organotherapy, such treatment being insti- 
tuted according to the predominating symptoms in the 
individual case. The study and practice of the treat- 
ment of psychiatry of insane cases in institutions and 
its relation to internal secretions and metabolism de- 
serves a great deal of attention. Much can be done 
along these lines for children before puberty, which - 
will help to prevent these psychic disorders later on. 
Dr. Sajous found that 65 per cent of all idiots are de- 
prived of their thymus before six years of age. 
Hyperparathyroidism is believed to be a cause of 
myasthenia paralytica (Chvostek) and of the rarer 
condition known as myotonia periodica. Thyroid and 
parathyroid therapy helps here. Parathyroid insuffi- 
ciency induces trophic disturbances of the skin, nails 
and hair; myotonia, myoclonia, tetany, myoclonic con- 
vulsive movements and epileptic seizures. These cases 
do exceptionally well on an anterior pituitary combina- 
