186 THE INTERNAL SECRETIONS 1920 



lent results from long-continued use of small doses of 

 thyroid with or without other synergistic endocrine 

 remedies. 



Type 3. The adrenal type of malnutrition includes 

 those emaciated, pale, tired-out children, who always 

 have circulatory inefficiency with cold hands and feet. 

 Their muscles are flabby, blood pressure is low, the ap- 

 petite carpricious, and mentality sluggish. Indolence 

 and disinterestedness is usual, and the generally low re- 

 sistance, marked asthenia and poor elimination of 

 waste products ofttimes is associated with a nephritis. 

 In this class I get the best results from applying the 

 principles of adrenal support so thoroughly emphasized 

 by Harrower, plus, of course, proper care of the emunc- 

 tories, well-enforced rest, and good food. 



Type 4. Certain children, of what might be called a 

 hyperadrenal type, show signs of sympathetic stimula- 

 tion, rapid heart action, unstable digestion, with fre- 

 quent gastric disturbances, and dilated pupils. The 

 skin is soft, moist, and there is a tendency to hyper- 

 trichosis. They are often emaciated and anemic, but 

 many of them tend toward an excessive development 

 of the body and ossification of the bones, and they ap- 

 pear tall, thin, and delicate. Often they are especially 

 predisposed to infection. In these cases anti-adrenal 

 measures give the best results, and since the pancreas 

 opposes the adrenals, combinations containing this 

 preparation are sometimes marvelous in their effects. 



Type 5. In many cases of so-called chronic consti- 

 pation in children, a more careful examination will 

 reveal other symptoms, which point to a condition of 

 hypothyroidism. These symptoms include a tendency 

 to obesity, laziness, fatigue, somnolence and anorexia. 

 There is a retardation of certain developmental pro- 

 cesses as dentition, walking and speech. Muscular and 

 arthritic pains are usual, and frontal and occipital 

 headache is common. Apathy, indolence, depression 



