496 VEGETATIVE DISTURBANCES 



is gay, comical, imbecile. I refer to the accompanying illustration. The 

 cheeks lack the thickness of myxedema and usually show a macular red- 

 ness. While in infantile myxedema or thyroaplasia the condition becomes 

 recognizable only some time after birth, Mongolism may be recognized 

 immediately "c'est un petit chinois." The fontanelles and sutures are open 

 abnormally long, dentition is somewhat delayed and somewhat irregular. 

 The teeth are defective, and the set of teeth mostly shows numerous ab- 

 normalities. (Degenerationsgebiss-F0g/); growth in height is usually 

 somewhat stunted, but there exists a difference from infantile myxedema 

 in that all these manifestations are very much less pronounced, and the 

 bone nuclei usually appear at the normal time or just a little later. In 

 many a case only isolated bone nuclei appear late (Vogt). Sieger t even 

 observed premature ossification of the epiphysial nuclei. Later there often 

 occurs a stunting of growth, and even a case of Mongoloid dwarfism has 

 been observed by Bourneville. The skin is smooth and moist; the pseudo- 

 lipomata of infantile myxedema are absent, and there often exists marked 

 obesity. The neck is regular, not shortened as in infantile myxedema. 

 The thyroid is present. Very commonly the abdomen is thickened, obstipa- 

 tion exists, and umbilical hernias are not rare. Kassowitz found umbilical 

 hernias forty-four times among fifty-five cases, and three times a hernia in 

 the linea alba below the umbilicus. Both the accompanying illustrations, 

 (Observation LXVII) for which I thank Dr. L. Mohr (Halle a. S), show the 

 Mongolian expression of the face. 



The skeleton is proportioned, slender, the children learn to sit and stand 

 late, the hands are rather small, awkward, the middle phalanx of the little 

 finger is often shortened, the end phalanx atrophic; also the thumb is often 

 very short (main mongolienne) . Very commonly the joints are extra- 

 ordinarily low, especially the joints of the hands and feet, but also the hip- 

 joints. The musculature is often hypotonic. Often other anomalies of 

 formation occur, such as congenital cardiac defects, and not rarely slight 

 strabismus or nystagmus. The genitalia are different from those of in- 

 fantile myxedema, in that they remain only a little behind in development. 

 In males, the penis and scrotum are often strikingly small, as Kassowitz found 

 nineteen times in thirty-nine cases, and Siegert in half the cases. Also there 

 may be delay in descent of the testicles. Later the genital functions are for 

 the most part normal, although libido may be very slight. The Mongoloids 

 are usually short-lived, and very sensitive to tuberculosis. The mental 

 development is most only delayed, or there may be slight imbecility and 

 but rarely pronounced idiocy. The children are rather lively, but their 

 attention is fixed with difficulty; they have considerable imitability and pose 

 readily. 



Hence there are very few features of infantile myxedema mixed in with 

 Mongolism. These are eventually a slight degree of dwarfism, the delay of 



