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considered a bright child. On July 27, 1916, the patient was brought to the Post-Graduate Hospital under the writer's care. Physical examination showed the following points : The child had a cretinoid facies ; his color was pasty. Men- tality was normal ; he stuttered. He was fairly well nourished and not obese ; there was general glandular enlargement. There was an eczematous eruption on scalp, forehead, face, entire neck, shoulders, elbows, arms, chest, thighs, and legs. The skin was dry and coarse and wrinkled on the forehead, forearms, and hands. No hair was seen on the body. The head was twenty inches in circumference: it? shape was regular and there were no bosses ; sutures and fontanellcs were closed. The hair was coarse and abundant ; the scalp showed a seborrhea and was covered with a thick crust. The face was pasty and the checks covered with a Non Prescription Cialis dry scaly eruption and Non Prescription Cialis crusts. The eyes were small and reacted to light and accommodation : the pupils were equal ; there was edema of upper lid. puffiness of the lower lids. Eyebrows were deficient. The upper eyelashes were normal ; the lower were scant Non Prescription Cialis and fine. The mouth was open ; the nose was saddle shaped ; the ears were negative. The tongue was moist and clean and seemed to fill the mouth : the mucous membrane was nor- mal. The teeth were regular ; the upper two incisors were decaying. Gums were normal. Tonsils w-ere small and imbedded ; adenoids were present but not enlarged. A •Ivrail licforc the Pediatric Society at the Academy of Medicine, November. 1916. Non Prescription Cialis EDELMAN: ECZEMA DUE TO HYPERTHYROIDISM. 451 tense, dry eruption involved the entire neck and there was general glandular enlargement. Because of the tenseness of the skin the child was unable to turn his head. The chest measured twenty-one inches in circumference and there was a scaly eruption on posterior surface; otherwise nega- tive. In the lungs a few coarse rales were heard pos- teriorly. The heart was negative ; pulse, normal. The ab- domen measured twenty-one inclics and seemed enlarged and distended. The liver and spleen were not palpable ; no tumors or masses were felt ; Non Prescription Cialis the abdomen was soft to touch and there were no tender areas or signs of fluid. There was slight umbilical hernia. There was no lordosis. There was an eczematous eruption from elbow to lingers ; the skin over the fingers was wrinkled and dry and the fingers tended to squareness ; the nails were brittle. There was an exudative eruption from knees to ankles ; the skin was coarse and rough. The penis was hyperplastic and in a state of priapism. Testicles, both in scrotum, seemed and felt normal. Refle.xes were normal. Urine was nor- mal. The blood on first examination showed hemoglobin, seventy per cent.; red blood cells, 4.200,000; white blood cells, 6,500; polymorphonuclears, 62; lymphocytes, 36; eosinophiles, 2. Second e.xamination showed hemoglobin, eighty per cent ; red blood cells, 4,600,000 ; wliite blood cells, 8,500; polymorphonuclears, 36; lymphocytes, 63. The Was- Non Prescription Cialis sermann and von Pirquet reactions were negative. Tem- perature was 98° F. On July 27, 1916, the patient was given 0.5 grain thyroid extract three times a day. No local treatment was pre- scribed and the diet was left alone. Bran baths Non Prescription Cialis were or- dered to be given every night. August 2d. Patient re- turned transformed into a diiTerent child. The eczema of face and neck had almost Non Prescription Cialis disappeared and he was able to move his head Non Prescription Cialis freely ; the eczema on the legs was improved slightly. The mother volunteered the statement Non Prescription Cialis that for the first time in three years the patient had slept through the nights. The itching remained about the same. Pro- tective measures were used to Non Prescription Cialis prevent scratching and the same dose of thyroid continued. Weight was thirty-one and one half pounds. August gth. Improvement contin- ued ; itching still persisted. The child weighed thirty pounds. Sodium bicarbonate baths were ordered instead of bran. Owing to rapid loss in weight — two pounds in fourteen days — we discontinued the thyroid Non Prescription Cialis extract and instead discontinued all sugars and fats from the diet and used I.assar's unguent as a local application. August 17th. The patient returned much worse; eczema had again ap- peared on face, scalp, and neck. The diet was then changed, allowing fats and sugars as previously, and again thyroid in 0.5 grain doses was given three times a day. Tempera- ture was Non Prescription Cialis 99° F. August 30th. Weight, thirty-one pounds ; again a marked improvement was noted. Thyroid extract was increased to one grain three times a day. September 25th. The patient continued to improve and gained in weight to thirty-two pounds. Since then the condition im- proved steadily, but not quite to the same extent as during the first week. At the present time, the weig'it was thirty- five pounds and he was receiving one grain of thyroid ex- tract three times a day. He still retained the cretinoid facies, and the skin eruption, while still present, was softer, paler, and considerably improved. Those wiio knew pa- tient previous to his treatment, could not believe he was the same child. He was eating better, bowels were regular, he was happier, wanted to play, and began to take more in- terest in his surroundings. Since then he has had a severe attack of measles, and when last seen, October, 1917, was enjoying good health. The skin was normal and he was in every respect a normal child. He has not been receiving any medication. This case presents so many interesting points, that I desire to devote the Non Prescription Cialis rest of this paper to the discussion of some of them. The interesting points in the history were the premattire grayness of the patient's mother and her sister and their rather pasty complexion which are suggestive of deficient thyroid secretion. It then becomes probable that the mother is responsible for this child's condition. The persistency and extent of the eczematous con- dition of the skin, in spite of careful dietetic and local treatment, suggests a rather complex etiology. The eczema bears no relation to the food. The following facts in the physical Non Prescription Cialis examination are sig- nificant : general cretinoid facies ; almost total loss of eyebrows ; puffiness of upper and lower lids ; pasty complexion ; dry and coarse skin Non Prescription Cialis ; slight lordo- sis ; apparent large abdomen, or pot belly ; umbil- lical hernia; anhidrosis or absence of sweating; extensive eczema ; a practically normal mentality. The miraculous improvement in Non Prescription Cialis the eczematous condition with the administration of thyroid and the remission when it was Non Prescription Cialis not given for a week, in spite of local and dietetic treatment, must be looked upon as additional evidence of the correct- ness of the diagnosis. We must conclude, then, that Non Prescription Cialis