THE THYROID GLAND 47 



external symptoms to be present, but there is 

 always mental lethargy. This condition may be 

 sporadic or endemic, the latter occurring chiefly 

 in goitrous districts. The gland in such places 

 may be large and hard, but deficient in thyroxin 

 contents. These symptoms in breast-fed children 

 do not come on till about the second year, when 

 they become dependent on their own thyroxin, 

 and not on that contained in the mother's milk. 

 In such cases thyroid feeding is a specific, and 

 must be carried on for some years. If the growth 

 of the child's limbs do not improve it will help 

 much to add pitglandin, the extract of the pars 

 anterior of the pituitary. In most cases of hypo- 

 thyroidism the blood-pressure is above the normal, 

 but if this is not the case and the circulation be 

 feeble cold and blue extremities, for instance 

 adrenal extract should be added. Each case 

 must be watched and treated on its merits 

 by various combinations. There are few more 

 brilliant or lasting triumphs in modem thera- 

 peutics. The cretin, from being a helpless burden 

 to its parents and almost an idiot, becomes a 

 fairly useful person, capable of education and later 

 of mental and manual capacity. As he grows 

 older his thyroid becomes more active, but help 

 from outside by thyroid feeding will probably 



