476 VEGETATIVE DISTURBANCES 



elder looked to be about three years younger than the other and showed 

 an entirely childish habitus. He also quotes the case of a boy of sixteen 

 years, who looked as if he were eleven years old, and whose psychical attri- 

 butes corresponded with that of the latter age. At the age of ten years of life 

 he had sustained an inflammation of the throat and a swelling of all lymph 

 glands; Brissaud here regards it as established that at that time the thyroid 

 gland was affected. The third case that Brissaud cites is, on account of the 

 inaccurate description, hard to classify. I need hardly detail more intimately 

 that the belonging of the cases cited to infantile myxedema is at least un- 

 certain, even unlikely. A priori we may withdraw from consideration, how- 

 ever, the classification on the etiological basis, according to Brissaud' s assump- 

 tion that a severe disturbance of development could depend on a thyroid 

 insufficiency without other symptoms of myxedema being present. The in- 

 hibition of ossification alone, on which some stress has been laid, is no certain 

 sign of thyroid insufficiency. Meige and Allard point out, it is true, as the 

 foundation of this assumption, a case of typical Lorain's infantilism in which 

 ossification had advanced much further than in a case of myxinfantilism. 

 E. Levi showed, however, that in the type Lorain the ossification is much de- 

 layed as compared with that of a normal individual of this age. It is certain 

 that also in true infantilism there exists a certain inhibition of ossification, 

 and that even a certain acceleration of ossification may follow thyroid gland 

 therapy. But this does not furnish a certain demonstration of the thyrogenic 

 pathogenesis of such cases, for, as Ferranini already mentions, the stimulation 

 of the metabolism through the administration of the thyroid gland may help 

 somewhat. To-day, when the manifestations of thyroid gland insufficiency 

 in childhood are so carefully studied, we would require unconditionally sure 

 signs of childish myxedema if we were to call a case myxinfantilism. The 

 delimitation of true infantilism from severe forms of childish myxedema is 

 indeed readily made. The mitigated forms may be distinguished from it by 

 the presence of myxedematous alterations of the skin, thickening of the 

 tongue and lips, the umbilical hernia, disturbances of intelligence, apathy, and 

 especially the result of thyroid gland therapy. 



Naturally there also occur mixed cases. Signs of thyroid gland insuf- 

 ficiency may be added to those of true infantilism, temporarily or perma- 

 nently. Perhaps such a case is described by Dupre and Pagniez. Here a 

 myxedema began at the fifteenth year of life in a case of true infantilism. 



Again, the delimitation of true infantilism from eunuchoidism is not diffi- 

 cult in most cases. It is quite unintelligible how Peritz can regard eunuchoid- 

 ism as the purest form of infantilism. In eunuchoidism we have an isolated 

 severe disturbance of the development of the sexual glands, and here the 

 analogy with eunuchoidism ends, the dimensioning of the body [in eunu- 

 choidism] has nothing in common with the childish dimensions. (There is 

 significant predominance of the length of the extremities and small head 



