, ADDENDUM 497 



the dentition and closure of the fontanelles, the distention of the abdomen, 

 the umbilical hernias, the constipation, the remaining behind in mental 

 development, the anemia. There are, however, cases of Mongolism in which 

 myxedematous symptoms are more prominent; Vogt, Neurath, and others 

 have described such cases. 



Pathogenesis and .Treatment. From what has been said, we should 

 expect that thyroid-gland treatment would have only a slight influence. 

 Sometimes not even acceleration of the dentition and closure of the fonta- 

 nelles follow. Only the umbilical hernia and constipation are improved 

 rapidly. Kassowitz says that in young children treatment with thyroid 

 gland will only anticipate the improvement that later occurs spontaneously. 

 In the case shown above, the results of its use may be regarded as extraor- 

 dinarily good. 



Although according to what has been said there tends to be present in 

 cases of Mongolism a slight temporary component of athyrosis, which may be 

 more strongly pronounced in certain rare cases, yet there is not doubt that 

 the clinical picture of this disease cannot be attributed to any disease of 

 the thyroid. This is confirmed by the fact that in the few autopsies thus 

 far recorded the thyroid for the most part was found to be normal (Neumann, 

 Comby, Bourneville) . Only Phillippe and Oberthur found in four cases 

 inflammatory sclerosis and Lange slight inflammatory changes. Bourneville 

 in five cases, and Siegert in one case saw a persistent thymus. The findings 

 in Mongolism do not present anything characteristic, and resemble those of 

 idiocy (Scholz). Kassowitz considers the simultaneous affection of many 

 ductless glands; which assumption lacks all objective evidence. Most 

 worthy of remark in an etiological direction seems to me the oft repeated 

 observation that Mongoloids are the last born in a family numerous in 

 children, or that the mother was very old or her strength had been reduced 

 .through illness. Shuttleworth therefore terms the Mongoloids the "products 

 of exhaustion." 



In the differential diagnosis from infantile myxedema, the X-ray examina- 

 tion, in addition to the Mongoloid expression of the face, is of importance. 



Addendum 



It is true that no term in medicine has been more abused than that 

 of "infantilism," and that any special work done on the individuals affected 

 with infantilism must be accepted with caution if the type of infantilism 

 and exact description of the individual be not clearly stated. The author's 

 attempt to delimit the affection is indeed very laudable; but it is true that the 

 determination of the fine shades of distinction is often very difficult. Thus 

 certain of the cases of pituitary tumor without apparent abnormal distribu- 

 tion of fat have been classed under the general term "infantilism." It is 

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