876 



AUGUST STKAUCH 



ment became normal. The same author in 1915 reported an additional 

 number of cases of cessation of growth, sexual infantilism with good 

 psychic progress, caused by chronic diarrhea in connection with pancreatic 

 insufficiency. Administration of pancreas extract corrected not only the 

 . diarrhea but strikingly improved the entire 

 physical development. Quite similar observa- 

 tions are recorded by Rentoul and Moorhead. 

 However, the question arises whether the infan- 

 tilistic syndrome is directly due to a disturbance 

 of the exocrin and endocrin secretion of the pan- 

 creas or to the constant diarrhea, and the ensu- 

 ing nutritional impairment, so that as a result 

 of the cure of the diarrhea by opotherapy an im- 

 provement of the general development takes 

 place. 



To R. Miller it appears that the types of 

 infantilism spoken of as pancreatic or intestinal 

 are all the same condition, namely such as result 

 from celiac disease; he uses the term celiac 

 infantilism, which term is noncommittal as to 

 the cause of celiac disease, while clearly de- 

 noting a type of infantilism in which the im- 

 pairment of development is due to that malady. 

 Its three cardinal features are enlargement of 

 abdomen, persistent or relapsing diarrhea with 

 pale fatty stools and retardation of physical 

 growth and development. 



That diabetes mellitus, the prototype of 

 endocrin pancreatic disorder does not lead to 

 infantilism notwithstanding the oftentimes se- 

 vere emaciation and other phenomena of a deep- 

 ly disturbed metabolism, may find its explana- 

 tion in the usually very rapid course of the dis- 

 ease that "in childhood grants no pardon" (von 

 Noorden) and issues in exitus lethalis. 



Bullrich, however, reported a case similar 

 in the clinical aspect to those of Bramwell, 



but with the difference that there was present also diabetes mellitus. The 

 patient at the age of nine years was normally developed. At 11% years 

 emaciation, polyuria, polydipsia and constipation set in. Later there was 

 continued severe diarrhea with steatorrhea. The body weight at 16 years 

 of age was only 21 kilos. The sexual organs were not developed; supra- 

 pubic and axillary hairs were absent, the hair on the scalp was scanty, the 

 face senile, the skin wrinkled. There was deficiency of the exocrin and 



Fig. 10. Infantilism due 

 to severe chronic intestinal 

 insufficiency. Boy seven 

 years old, beside a normally 

 developed boy of the same 

 age. Since his sixth month 

 of life very frequent at- 

 tacks of severe diarrhea last- 

 ing 1V_> to 2 weeks. Stools 

 voluminous, three to five 

 daily, liquid, malodorous. 

 Meteorism. Body weight, 25 

 Ibs. Height, 33 VL. inches. 

 (Cook County Hospital case 

 No. 762606.) 



