INFANTILISM 475 



Also the liver diseases acquired in early life may lead to infantilism. 

 Lereboullet described a case in which he ascribed hypertrophic biliary cirrhosis 

 of the liver as the cause of the infantilism. The following case also perhaps 

 belongs in this group. 



Observation LX. G. A., twenty-one years old. Entered Nov., 1909. Since early- 

 youth strong imbiber of alcoholic liquors. In 1906, he fell in the water, after which 

 pneumonia, later pleurisy. Since that time has not grown much. For about two 

 years, swelling of the abdomen, edema of the legs, and enlargement of the liver. The 

 ascites subsided, the liver remained large and painful. 



According to his statement, for about three years after the time of puberty the patient 

 had libido and erections, that later ceased. Never pollutions, never cohabitation. 



Very considerably enlarged liver, painful to pressure, pole of the spleen palpable, 

 heart dullness somewhat enlarged to left and to the right. Extra-systoles, no ascites, 

 no albumin. 



The physiognomy is juvenile, no beard, no axillary hair, sparse growth on mons Ven- 

 eris. Testicles and penis of normal size. 



Differential Diagnosis. If we confine ourselves to the symptoms just 

 described, the delimitation of true infantilism from the diseases of the ductless 

 glands associated with infantile features is not difficult. 



And yet on closer examination of the individual cases described under the 

 same infantilism we find that very frequently later authors confuse in- 

 fantilism with diseases of the ductless glands. Thus I would hold that in the 

 communication of Richon and Jeandelize the first of the cases described was 

 probably an eunuchoid, the second a cretinoid, and the third perhaps a 

 true case of infantilism. Another example: In the communication of E. 

 Levi, I regard the first case as one of hypophysial dystrophy, the second is 

 difficult to classify,' the third is perhaps a typical case of true infantilism. 



I would detail somewhat more exactly the most important differential 

 diagnostic features: 



Let us begin with the delimitation from infantile myxedema. In the 

 French school two types of infantilism are distinguished, the Lorain's type, 

 which on the whole is true infantilism, and second, myxinfantilism. When 

 however we go back to Brissaud's original publication, we find that the char- 

 acterization of myxinfantilism is very inexact. Here begins an error that 

 has continued until the present and that may be regarded as the chief 

 cause of the prevailing confusion. Brissaud describes myxinfantilism in the 

 following manner: The face is round, the lips are thick, the nose small, the 

 cheeks are thick, the genitalia infantile, the thyroid gland small, the ossifica- 

 tion is delayed, dentition is retarded or fails, the neck is short, and there 

 often exists lordosis of the lumbar spine; among the individuals belonging to 

 this type there are also those whose health may be very good. Brissaud held 

 the opinion that in the majority of cases myxinfantilism is not an etat morbide 

 and he refers also partial infantilism to an insufficiency of the thyroid 

 gland. As an example he quotes the cases of two sisters of whom the 



