ENDOCRINOLOGY IN PEDIATRICS 185 



Type 1. Marasmic cases seen in infancy have been 

 shown to be associated with an abnormally early 

 atrophy of the thymus gland. In treating these cases 

 all attempts at drugs, wet-nursing and artificial infant- 

 feeding often failed. Within the past three years I 

 have been giving thymus gland with small doses (gr. 

 1/8) of thyroid with excellent results. This treatment 

 I keep up for several months, with intervals of ten days 

 every six weeks. In the milder forms of infantile 

 atrophy, resembling rickets, the little patients fare bet- 

 ter with a pluriglandular combination of the above 

 with lymphatic gland, such treatment favoring the 

 mineral metabolism and lymphatic circulation as well 

 as the cellular oxidation, which it will be recalled, is 

 largely controlled by the thyroid gland. 



Type 2. Rachitis, or impaired nutrition, with alter- 

 ations in the growing bones of children, sometimes lat- 

 ent up to the ninth or twelfth month, is due to calcium, 

 phosphorous or mineral metabolic disturbances. Asso- 

 ciated with this we have sluggish lymphatic activity, 

 retention of the cellular toxins and often a resultant 

 hypoadrenia. With this frequently one finds an asso- 

 ciated hypothyroidism and dyspituitarism as evidenced 

 by the low blood pressure, tendency to dwarfism, mus- 

 cular and arthritic pains, sluggish mentality, soft and 

 flabby tissues^-especially the skin, which sometimes 

 resembles myxedema ; muscular weakness and various 

 abnormal changes of the bones and cartilage with lack 

 of calcium deposition. In these cases it is well to note 

 also the close relationship of rickets to hypoparathy- 

 roidism since these children often suffer from infantile 

 convulsions, tetany and laryngysmus stridulus, which 

 class of disorders are akin to the convulsive type of 

 difficulties which have been definitely connected with 

 parathyroid insufficiency. As a result of these condi- 

 tions in these cases we sometimes find an enlarged 

 spleen, liver and lympathics. In such cases I get excel- 



