ENDOCRINOLOGY IN PEDIATRICS 187 



and mental retardation make a picture that may be 

 indeed pathetic. Not infrequently there is also an im- 

 perfect development of the sexual organs and functions. 

 Thyroid therapy gives excellent results in such cases, 

 though the treatment must be long-continued and the 

 dose increased from time to time, carefully watching 

 for symptoms of thyrotoxicosis, such as tachycardia, 

 insomnia, headache, pain in the back and limbs, trem- 

 bling and prostration at the slightest evidence of 

 which the dose should be promptly reduced. 



Type 6. Malnutrition, accompanied by hyperthy- 

 roidism, occurs usually in older children, beyond 

 puberty, and the difficulties may begin at that time. 

 Exophthalmos may be associated with this condition, 

 but it is rare. These individuals usually are tall, thin, 

 and high-strung. They appear anemic and manifest 

 many of the symptoms that one finds with hyperadrenia 

 (Type 4) . They are very temperamental and excitable 

 and some of them exhibit a tendency towards precocity 

 or even genius. The influence of hypercrinism upon 

 the vegetative system brings about the symptom-com- 

 plex known as sympatheticotonus. Cardiovascular dis- 

 turbances are the rule, tachycardia is common, and fre- 

 quently bounding arterial pulsations in different parts 

 of the body are noted on examination and are sometimes 

 an annoyance to the patient. The skin is moist and 

 periodical vasodilation occurs very easily. These indi- 

 viduals blush easily. Hypertrichosis is occasionally 

 found, and it is remarkable how frequently urticaria or 

 similar dermatoses are found. The large, brilliant, oft- 

 times slightly protruding eyes are rarely associated 

 with exophthalmos and conditions of this kind may be 

 easily mistaken for multiple sclerosis. They also may 

 suffer from such neuropsychic conditions as migraine, 

 neuritis and mental disorders. The use of the adrenal 

 sympathetic sedative formula, originated by Andre 

 Crotti of Columbus (pancreas, adrenal, pituitary, and 



