130 THE DISEASES OF THE THYROID GLAND 



X'ov. 10. 150 gm. dextrose, no sugar. 



Nov. 16. Skin entirely dry. o.oi gm. pilocarpine; no salivation, only slight sweating. 



"Nov. 19. Nervous status. Superficial abdominal reflexes increased and also plantar 

 reflex lively; otherwise normal, as far as can be investigated. 



Only very slight mydriasis after homatropine. On Nov. 22, o.ooi gm. adrenalin 

 subcutaneously and 100 gm. grape-sugar by mouth. Minimal increase in blood-pressure, 

 lasting only for a very short time. Pulse only 84 to 92. In the first two-hour period, no 

 sugar; in the second, 4.25 per cent, in 15 cc. urine; in the next twelve-hour period, Trammer 

 still strongly positive. 



Xov. 26. o.ooi gm. adrenalin, no sugar. 



Xov. 29. Circumference of skull, 56^ cm., total height, in cm. Circumference of 

 abdomen, 62 cm., circumference of breast (mammillae), 64 cm., circumference of neck, 28 

 cm. Upper arm (acromion to olecranon), 21.5 cm., arm proper, 18.5 cm., lower extremity 

 ([anterior superior] spine to heel), 52 cm. 



Dec. 2. Up to this time, pulse between 100 and no. Bowel movements not entirely 

 regular, in that one bowel movement is wanting every three to five days. From now on, 

 five thyroidin tablets a day. From Dec. 6 on, seven tablets a day. Dec. 8, nine tablets 

 a day. 



During the next days the pulse rises up to 145 and sinks to its former count only on 

 Dec. 22. 



Leucocytes: 10,200, of which: 

 Polymorphonuclear neutrophiles, 67.2 per cent. 

 Large mononuclears, 8.2 per cent. 

 Lymphocytes, 22.6 per cent. 

 Eosinophiles, 2 per cent. 



X-ray examination of the hand skeleton. The epiphysial junctures of the fingers 

 and metacarpal bones are still open. The skeleton of the carpus is as yet laid out in the 

 form of round bone-nuclei. At this age the carpal bones should be fully developed, 

 and the epiphysial junctures should be closing up (Fig. 16). Sella turcica corresponding 

 to the size of the skuli. 



Summary. Sporadic cretinism probably due to aplasia or high-grade hypoplasia of 

 the thyroid gland. The thyroid-gland therapy instituted in the sixteenth year is able to 

 affect the growth not inappreciably and to further intellectual development. We may 

 readily comprehend that the marked inhibition of development that has existed for 

 sixteen years cannot entirely be done away with. 



The investigation of the carbohydrate metabolism showed that after the year-long 

 administration of thyroidin the assimilation limits for grape-sugar lay abnormally low. 

 It is very instructive that with the discontinuation of the thyroid medication the assimila- 

 tion limits rose immediately, so that after several weeks as much as 150 gm. dextrose 

 would be borne. Also adrenalin produces no glycosuria, while, on the contrary, adrenalin 

 and grape-sugar produce abundant glycosuria. 



An over-loading test with thyroidin showed that the tolerance in this case was at 

 any rate rather high, as symptoms of poisoning first occurred only with large doses. 

 Under the test with thyroidin, the number of neutrophiles rose considerably, and the 

 assimilation limits for grape-sugar again sank rapidly. 



In the clinical picture of sporadic cretinism the phenomenon most be- 

 fore the eyes is the disturbance in growth. Buschan collects from the litera- 

 ture thirty-four cases of sporadic cretinism that showed evident dwarf- 

 ism. In the cases with high-grade disturbance of the function of the thyroid 



