126 THE DISEASES OF THE THYROID GLAND 



of the skeleton of the face. Very low forehead, eyes stand wide apart. Saddle-nose, 

 epicanthus; short, very broad cartilaginous nasal framework; cushiony lips; thick, 

 broad tongue, that protrudes from the mouth. Cushiony ear lobes that lie close to the 

 head. Cheeks very thick, throat thick and stubby. Thyroid not palpable. Thick 

 lanugo hair on back. Skin of the body, especially in the supraclavicular grooves and 

 on the backs of the hands and feet, springy, elastic; hands and fingers chubby. Abdomen 

 much distended. Circumference 65^5 cm. Reducible umbilical hernia. Reflexes, as 

 far as can be tested, present. Noise tests were without any reaction. 



From June 23 on was given one thyroidin tablet daily, until Oct. 24. Entrance into 

 the first medical clinic. Now length of body 91.25 cm., weight 21 kg. Treatment is 

 now discontinued. 



Circumference of the head now 56 cm., circumference of the abdomen 65 cm., cir- 

 cumference of breast 49 cm. 



Anterior superior spine to internal malleolus 44.5 cm. 



Circumference of neck 36 cm. 



Heart dullness somewhat broadened (also by X-ray, heart of characteristic spherical 

 shape). Heart sounds pure. 



Border of the liver palpable 10 cm. below the margin of the ribs in the mid-line, 

 two fingers' breadth below in the right mammillary line. 



Umbilical hernia about 3 cm. long, and its insertion 2.5 cm. in diameter. Penis very 

 small, testicles have not descended. The child does not go to the toilet to void urine or 

 feces. Slight heightening of the patellar reflexes, otherwise the reflexes normal. Nervous 

 status, so far as can be tested, normal. 



The child often stares into space for a long time, but at times is right lively and cries 

 loudly. No trace of speech. Puts all objects into his mouth, even his own feces. Im- 

 pressions of hearing entirely absent, no reaction of the eyelids to sounds. 



Nov. 2. 50 gm. dextrose per os, no sugar. After several days 100 gm. dextrose 

 of which he vomited a small amount, no sugar in the urine. 



Nov. 9. Erythrocytes, 5,480,000. 

 Hemoglobin, 70 per cent. 

 Leucocytes, 9000, of which: 

 Polymorphonuclear neutrophiles, 42.5 per cent. 

 Large mononuclears, 8 per cent. 

 Lymphocytes, 41 per cent. 

 Eosinophiles, 8.5 per cent. 



A later count yielded: 



Erythrocytes, 5,400,000. 

 Hemoglobin, 70 per cent. 

 Leucocytes, 11,000. 

 Eosinophiles, 12 per cent. 



Nov. 21. o.oi gm. pilocarpine. Sweat extremely slight, salivation negative. 



Nov. 22. Homatropine evinces weak mydriasis only, which however is positive after 

 twenty-four hours. 



Nov. 26. o.ooi gm. adrenalin subcutaneously and 50 gm. dextrose per os. After 

 four hours 4.2 per cent, sugar. 



Nov. 29. Weak mydriasis forty-eight hours after installation of homatropine. 



Nov. 30. o.ooi gm. adrenalin subcutaneously, no sugar. From Dec. 2 on, three thy- 

 roid tablets a day; from Dec. 5 on, five tablets daily; from Dec. 8 on, seven tablets daily. 



Dec. 13. Marked scaling of the skin, no trace of moisture, even of the palms. 



Dec. 22. Pulse irregular, only 72 to the minute, although frequent abortive beats. 



