438 NELSON W. JANNEY 



atotis patches on the skin, deficient perspiration and slightly protuberant 

 abdomen. J^fetabolic studies were similar in result to those of her brother, 

 except that the inability to retain nitrogen was not so marked. (See Table 

 1.) Rontgenologic studies showed bony structure and ossification centers 

 normal for age. This case, in view of the family history, was regarded as 

 probably hypothyroid, and was, put through a therapeutic test. On treat- 

 ment growth became normal, and from September 16, 1919, to December 

 28, 1919, the child gained 4 Ibs. 14 oz., which is more than she had gained 

 during the previous two years. This growth was attained on gr. % daily 

 of standardized thyroid extract. 



This case is interesting on account of the slightness of the clinical signs 

 and the prompt resumption of normal growth on a very small amount of 

 thyroid substance. 



Hypothyroidism in Adults. Masked HypotJiyroidism in the Adult. 

 Case 199, female, aged 36 years, married; no children. Of a neurotic 

 family "of little endurance." Two cousins had pulses averaging 52 and 

 54. One, an under par individual, cured by thyroid treatment. Patient 

 gives a history of normal growth, development and menstruation but has 

 always been highly nervous and becomes exhausted on slight exertion. 

 Occasionally is confined to bed for this cause. Though married 13 years, 

 never became pregnant. Patient complains also of pain in base of neck 

 and left shoulder. Is gaining weight slowly. 



Physical examination : Facial expression neurotic, not myxedematous. 

 Stature 5 ft. 9 1 / /> ins.; weight 188 pounds; but appearance not obese. 

 Adipose tissue generally distributed. Flabby musculature. Cool extremi- 

 ties ; skin and nails normal ; hair distribution normal except hair on tem- 

 ples is very low and slight prolongation of crines pubis to umbilicus. 

 1 lands gracile, tapering fingers. Hips more adipose than rest of body. 

 Thyroid somewhat small ; normal to palpation. Somatic organs normal. 

 Chronic inflammation of tonsils only demonstrable seat of possible focal 

 infection. Blood pressure normal. Temperature 96.6. Pulse 56; res- 

 piration 16. Laboratory Data : Urine and blood count negative. Differ- 

 ential count : polymorphonuclears 62, lymphocytes 34, large mononuclears 

 1 1/3, eosinophiles 2/3, basophiles and transitionals 2, per cent. On 

 a Schmidt test diet of three days' duration, the stools were essentially 

 negative. The basal metabolism ranged from - 10 to 20 by small 

 Benedict apparatus, six observations. Rontgenological examination, a 

 normal solla turcioa measuring width 13 mm., depth 10 mm. The 

 cervical spine showed an abnormal prolongation of the transverse process 

 <>f the 7th cervical vertebrae, that on the left side being % inch longer 

 than tho right, transverse process. Long bones negative. Epiphyses 

 normal closure. 



Chmcdl llesume: Neurasthenia is strongly suggested by the family 

 and parents' histories. An apparent or exciting cause is not lacking for 



