398 NELSON W. JANNEY 



symptoms usually become apparent from the sixth month according to 

 statements in the literature. Kocher has ascribed this retardation to the 

 protecting influence of the mother's milk. There seems, however, much 

 doubt whether this explanation be correct (Erdheim, Siegert, etc.). In 

 the first place, the young infant leads a nearly automatons existence and 

 incipient hypothyroidism could well go unnoticed for some time. Again, 

 hypothyroid cases have been reported by unusually observant clinicians 

 such as Siegert and Henry Koplik in which the symptoms appeared one 

 month to five weeks after birth. A short period of immunity from hypo- 

 thyroidism does, however, seem to exist. This the writer is inclined to 

 think may be due to the action of a certain amount of maternal thyroid 

 hormone remaining in the tissues of the child after cessation of the fetal 

 circulation. This lasting effect of the active principle of the thyroid has 

 been observed both experimentally and clinically. 



It is doubtful whether an athyroid individual ever survives the age 

 of childhood. Most die in infancy or in the earliest years of life. The 

 oldest case appears to be that of MacCallum and Fabyan, a myxedematous 

 female aged 13 at death. She had not learned to stand, and was able to 

 utter only the words a Papa" and ''Mamma." There was practically a total 

 failure of body development. The extremely low resistance of all tissues 

 against infection seems to play an important part in the early demise of 

 athyroid children. The cases of longer persistence of life which are 

 occasionally reported are probably to be accounted for by the presence 

 of accessory thyroid tissue which tends to develop at the base of the 

 tongue and elsewhere. The cases of F. Beach and Bourneville (a) which 

 lived beyond puberty fall, in all likelihood, into this category. Bourne- 

 ville's athyreotic had reached the 37th year. Both cases, on microscopic 

 section of the thyroid region, showed no thyroid tissue. In the more 

 painstakingly studied cases such as Marchand's, who lived to adult age, 

 rests of thyroid tissue were discovered demonstrating them to be hypo- 

 thyroid [ind not athyroid cretins. 



Formerly it was supposed that the symptoms and signs of thyroaplasia 

 were due also to absence of the parathyroid glands. Maresch, however, 

 nicely demonstrated their presence in his well studied case. This is most 

 important for the clear differentiation of thyroid from parathyroid func- 

 tion. The child was a female reaching the eleventh year of life. Growth 

 ceased at about eighteen months, the total height attained being about 

 2 feet, 8 inches. It is interesting to note that apparently the other duct- 

 less glands were normal. Occasionally the hypophysis is reported en- 

 larged in athyroidism. It is probable that thyroaplasia would be less 

 uncommonly reported if more cretins, dying early, w r ere autopsied and the 

 cervical region sectioned microscopically. 



Fetal Ailiyreosis in. Animals has been interestingly described by G. 

 Enuis Smith. This disease is very common among swine in Montana and 



