INFANTILISM 875 



but at puberty becomes more evident, especially in the retardation of the 

 sexual apparatus. Hochsinger considers the possibility of general vascu- 

 lar alterations playing hereby a role, since such were found in all his cases. 



Intestinal and Pancreatic Infantilism. Dystrophic infantilism has 

 been occasionally observed in connection with chronic disorders of the 

 gastro-intestinal tract with consequent malnutrition and atrophy. How- 

 ever, we must not lose sight of the fact that infantilistic constitution from 

 any cause may predispose to intestinal insufficiency as to other diseases, 

 such as tuberculosis, etc., forming thus a vicious circle. Babies with poor 

 digestion and assimilation are puny and meager for a long period of time 

 and their psychic progress is also retarded. This delay in most instances 

 is only temporary. However exceptionally the individuals affected may 

 remain small, puny, dystrophic in the full sense of the term. The prin- 

 cipal factor is a very severe chronic intestinal insufficiency with much 

 reduced function of the digestive glands which is rather refractory to 

 treatment and as a rule affecting children beyond the stage of infancy. 

 The tolerance for fats and carbohydrates is reduced so that slight dietary 

 indiscretion or a minor parenteral infection brings on a digestive disturb- 

 ance of severe nature with marked loss of body weight and a reparability 

 of function far below normal. But also without such recognizable causes 

 obstinately relapsing diarrhea of a fermentative character will occur. In 

 addition, or rather as a consequence of this, the somatic development be- 

 comes seriously impaired and finally the children are set back in body 

 weight and height by years. The clinical syndrome has led Herter to speak 

 of intestinal infantilism. In 1909 he described several children, all under- 

 developed due to chronic relapsing diarrhea. The feces had a character- 

 istic bacterial flora (Bacillus bifidus, Bacillus infantilis), were voluminous, 

 gray or light brown in color, usually gruel-like in consistency and of sour 

 odor and excessively fatty. There existed a moderate degree of anemia, 

 flabbiness of the musculature and marked meteorism. 



Similar clinical observations are communicated by Freeman, Heubner, 

 Schulz, Moorhead and others and undoubtedly have been made by many 

 of us. As this form of infantilism does not originate from a primary 

 deviation of the Keimanlage from the normal or some anatomical lesions, 

 but is due to a functional insufficiency, the prognosis is not gloomy in 

 spite of the most severe atrophy these children present. The great ma- 

 jority of the cases under proper treatment finally gradually recover (Heub- 

 ner). H. Gilford classifies this type as infantilism by deprivation. 



Byrom Bramwell (a) in 1904 described what he termed pancreatic in- 

 fantilism, which undoubtedly is allied to the foregoing type. His patient 

 was a male, 18% years old, with the aspect of an eleven-year-old boy. 

 From his ninth year he had diarrhea. The epiphysial cartilages were 

 still ununited. Under treatment with pancreas for two years the patient 

 grew 5% inches in height and gained 23% pounds. The sexual develop- 



