434 NELSON W. JANNEY 



and not very active at play and had failed to grow for past few months 

 only. His disposition was laissez faire in type. 



Physical examination showed the following : Apparently very healthy 

 boy; skin dry; no axillary nor pubic hair, genitals undeveloped; hands 

 and feet cold; fingers short, rather stubby; same true of hands and feet; 

 hands and feet slightly cyanotic ; no cutaneous atrophy ; skeleton symmet- 

 rically developed. Hair of head abundant, a little dry; eyebrows very 

 scanty, particularly outer thirds ; eyelashes normal ; ocular movement nor- 

 mal, V"P ils dilated ; ear-lobes normal ; moderate deviation of septum to 

 right; very high arched palate; tongue, no tremor; panniculus normal. 

 Teeth normal in appearance but first pre-molar on either side not erupted. 



norms rn 



Fi. 17. Masked hypothyroidism ; boy of 12 years. Note resumption of growth 

 on thyroid treatment. (From Janney and Henderson, Arch. Int. Med., Vol. xxvi, pp. 

 207-318, 1920, by permission.) 



Thyroid scarcely palpable, apparently some tissue on the right side; isth- 

 mus palpable. Lungs normal. Heart normal size. Sounds: musical sys- 

 tolic murmur, high pitched, heard close to sternum at apex. Abdomen nor- 

 mal in appearance ; liver not enlarged ; no abnormalities. Reflexes normal. 

 Pulse rhythmic and normal rate. Temperature subnormal. Respiration 

 normal. Initial basal metabolism rate was found to be 27. Glu- 

 cose tolerance test could not be carried out. The urine is normal ; blood 

 count, hemoglobin 88 per cent; leucocytes 11,000, erythrocytes 5,450,- 

 000, polymorphonuclear leucocytes 65 per cent, neutrophiles 32.3, 

 mononuclears 1.0, basophiles 0.3, eosiriophiles 0.6. Diagnosis, Hypothy- 

 roidism of masked type. 



The course of the case 4 is well shown by the accompanying figure. It is 

 remarkable inasmuch as a few weeks after thyroid treatment was instituted 

 hyperemic areas were observed developing in the region of the eyebrows. 

 A short time later, the absent two-thirds of the eyebrows began to grow 



