out by Dr. Ward, which I now use. No evidence of neurotic or other disease was discovered in the father or mother of this child, they are apparently strong and healthy. Annie is now three (3) years old. At birth labor was easy and rapid; she weighed seven pounds, and appeared to the mother as healthy as her other children, except that she had the "snuffles," and her eyelids appeared a little swollen; she ate and slept well. When she was three months old, the parents and friends began to observe that she was not growing and was unusually quiet and apparently stupid. In the past year and a half there has been no increase in her size, or progress in her mental development. At present her vocabulary is confined to the words "Mama" and "Papa." She notices only the members of the family, and they very vaguely. She eats well, but suffers from constipation. She has never walked, but can stand, though somewhat unsteadily, by holding on to a chair, or other object; she is unable to get up after falling down; she can creep; she sleeps a greater part of the twenty-four hours; rarely cries. The mother gives, without any questioning, the following information: She noticed that the child had peculiar attacks or "spells" occurring at irregular intervals, averaging once a month, during which she was irritable and feverish; the lips and feet would become purplish and cold, and the entire half of the body would become swollen, and that side would be distinctly larger than the other side; the child during this attack would seem to be suffering from difficulty in breathing and stiffness of the muscles, but was not unconscious. This condition would last for from one to three days, and gradually subside. The enlargement was not always on the same side. The child presents the peculiar, old expression, which is so characteristic of the disease in a large proportion of cases. The entire face is swollen and puffy (as can be seen from the photograph), especially the eyelids. The upper and lower extremities are also the seat of swelling; the feet are cold and cyanotic. The body of the child is large in proportion to the height; the abdomen is very large; the head is fairly well proportioned; anterior fontanel is not closed; teeth good; tongue only moderately large; the neck very short; thyroid appears to be absent, or atrophied; there are no fatty growths in the region of the neck; the hair is coarse and scanty; the skin rough and dry. The following measurements were taken: From external auditory meatus, over head, to the opposite meatus, A, 11 inches; from base of nose to occipital protuberance, 11 inches; occipitofrontal circumference, 17 inches; around chest, at mammary

region, 20 inches; lower thorax, 21 inches; abdomen around umbilical region, 19 inches. On July 5th she was given five grains of desiccated thyroid twice a week, mixed with her midday meal. The child was at this time at the house of its parents; here it was found difficult to carry out the treatment with any degree of satisfaction or certainty. Dr. Richard Shaw kindly admitted her to the Long Island College Hospital at my request. Here

the treatment was continued. After each administration of the thyroid there was a slight elevation of temperature for some hours; otherwise there was no apparent effect from the thyroid, except, in the decided improvement in the child's mental activity; she gradually became more observant of persons around her, noticed other children in the room, pictures, and flowers, would smile when spoken to, and her attempts at walking were very much bet

ter than formerly. The change in the mental condition was apparent to all who saw her. After a stay in the hospital of several months, she was returned to her parents with instructions to continue the treatment. The ultimate result in this case can only be known after a long administration of the gland, but unfortunately, in this particular case, there is not much probability that the parents will continue its administration.

CASE II.-The beneficial effect of the treatment is more marked in a child of refined relations who is under my observation. I saw this child through the kindness of Dr. McCorkle, who sent her to me. She is twelve years old. She was seen in December, 1894. As far as is known her birth was quite normal. Until four months of age she appeared natural. The relative who gives the history did not see a great deal of the child in its earliest

life, but she recalls that it would drink only when lying on its back. The child was not seen again by the relative, who now cares for it, until she was four years old, when there was a great change. The mother was in poor health at time of the birth of the child. Two months before she gave birth to the child, it was known that she had some pulmonary disease; owing to her enfeebled condition the child was not nursed; a rapid phthisis developed and she died. The father is now suffering from paresis (?); he was always of dissipated habits; one of his sisters was insane; she was very vain and had extravagant ideas of her own importance; she was incapable of doing any work. The father was always a peculiar man, quarrelsome, and in his younger days often became involved in brawls. When the child was seen at four years of age, she was small, had long hair, moved about on her hands and feet (not on her knees). She could not speak; under the care of her relative she has grown, and improved to a moderate degree; now she can say a few words, and can repeat a few others which she hears; she apparently understands much that is said to her. She has the heavy, dull facial expression, the puffy face, extreme pallor ; is small in stature; tongue not large; skin rough ; hair scanty and coarse; bowels constipated; appetite capricious, inclined to eat but once a day. Her height is thirty-eight inches. The accompanying photograph will show better than any description her appearance; it was taken a few days after my first seeing her. She was given five grains of desiccated thyroid twice a week, mixed with her food. As the child lives in the country, I did not see her when she began the use of the powders, but her relative has accurately informed me, by letter, of her condition. The first three powders taken produced no perceptible change. She left Brooklyn upon taking her fourth powder; was quiet and well on her journey; the next day, December 18, 1894, "she was quite ill, evidently with headache, and later in the day terrible vomiting;" "on the 19th she had an unusual movement from her bowels;" the same on the zoth. On the 21st of December, she took her fifth powder, and on the 22d of December she was again very ill with vomiting. Since taking the fourth powder, she has been "very feverish and terribly nervous, her little fingers were twitching incessantly, even in her sleep, and she was so painfully excitable that I felt tempted to give up the thyroid treatment.

The family had observed that the child was changed. The temperature was not constantly taken, but when it was there was no elevation. Quoting again from my correspondent's letter, "On

Saturday last and Monday of this week" (letter dated December 29, 1894) "J. had talking fits, when she talked incessantly in her own fashion, it was only gibberish." "She talked and talked until she was quite hoarse and exhausted, and she became really quite frenzied, and I could not get her to sleep until toward ten o'clock." "This week her bowels have moved without any cathartic, a most unusual thing." "She has grown very much thinner, noticeably in the face and neck." There has always been. some defect and unsteadiness in the neck of this child. In a letter dated January 9, 1895, my correspondent says: "The child is very much changed since the photographs were taken." "She has lost from eight to ten pounds in weight, or else, she has more spring in her, and is not such a dead weight." "Her complexion is generally quite brilliant now, and her flesh, all over her body, is different, there is life in it, and her bowels move quite regularly, every day, though her appetite is still very small. She has had no more vomiting spells." She is now taking 2 grains of the desiccated thyroid twice a week, the quantity having been reduced, by my direction, when she began to vomit and be excited; since these records the child has continued to improve; she has grown somewhat; wears a larger shoe and clothing than she did; is very much brighter; has added to her vocabulary; takes an active interest in the things about her, flowers and children; there has been a very decided improvement in her walk; her skin has become soft and presents a healthy flesh-color, her cheeks are often rosy; the hair is now soft, formerly it was coarse; she walks much better, and has abandoned a brace which she formerly wore. A photograph taken recently, and on about the same scale, will indicate, when compared with the former one, the change in her facial expression, and, consequently, in the improvement of her mental activity.

CASE III. This boy is seventeen years old (now eighteen). When he was born he was apparently well; he was one of eleven children, he being the oldest. The eleventh child died of marasmus, the mother says; one died of scarlet fever; another died from convulsions, during an attack of measles; the remaining children are well. The mother's health is good. The father was always well, but in the past two years he has suffered from some trouble. She says he is feeble on his legs, his mind is weak and he cries easily. The boy never walked until he was three or three and a half years old, and did not talk until he was four years old; when he did walk, he did so imperfectly, so that braces were put