Pediatrics. . hole expressionis dull and apathetic. Mucous membranes are normal in color,tonsils are not enlarged. The supra-clavicular spaces areprominent. No thyroid gland is palpable. The muscularsystem is well developed, cutaneous reflexes are sluggish,tendon reflexes well marked; no rachitic rosary, no enlargedepiphysis. Examination of the lungs reveals nothing abnor-mal. The cardiac apex beat is not palpable when patient issupine. When she lies on her left side it is found in the fifthintercostal space one-half inch outside the mammary right border of absolute cardiac dulness is
Pediatrics. . hole expressionis dull and apathetic. Mucous membranes are normal in color,tonsils are not enlarged. The supra-clavicular spaces areprominent. No thyroid gland is palpable. The muscularsystem is well developed, cutaneous reflexes are sluggish,tendon reflexes well marked; no rachitic rosary, no enlargedepiphysis. Examination of the lungs reveals nothing abnor-mal. The cardiac apex beat is not palpable when patient issupine. When she lies on her left side it is found in the fifthintercostal space one-half inch outside the mammary right border of absolute cardiac dulness is coincidentwith the left margin of the sternum ; the upper border beginsat the upper border of the fourth rib. The second aorticsound is accentuated; no murmurs are to be heard; pulserate 80. Splenic dulness not demonstrable, and the organcannot be palpated. Liver dulness extends from the upperborder of the sixth rib to two fingers breadth below the lowerborder of the ribs. Genitalia are normal. Urine contains. 614 PEDIATRICS. nothing abnormal. Her mental condition is infantile. Shecannot now repeat any part of the alphabet. She can callfairly accurately the names of domestic animals from thepictures in a childs book. March 22, 1897.—Owing to the mothers reluctance tobelieve that anything could be done for this child, treatmentwas not begun until August 12, 1896. Armours preparationof dessicated thyroid was then given her in 1 y2 grain dosest. i. d. It was being administered irregularly, and in Novem-ber, 1896, the mother was persuaded to place her in theChildrens Hospital, since which time she has been under con-tinuous observation. It has been found, after numeroustrials, that she will not tolerate more than six grains daily ofthyroid. Her improvement has been rapid and definite. Thegeneral details of this are to be seen by comparison of thephotographs. The anterior fontanelle has closed, the baldnesshas disappeared. The abdomen has lost its extreme promi-nence. Two permane
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Keywords: ., bookcentury1800, bookdecade1890, booksubject, booksubjectchildren
