The contribution which I have to make has to do with the action of the pars intermedia of the pituitary gland. These particular activities of the gland, from a therapeutic standpoint, have become apparent through a study of an abnormal child carried on for the past two and a half years by me, and previously by several physicians connected with the dispensary of the Babies' Hospital, including Drs. Kerley and Van Ingen. The patient was seen first on Sept. 1, 1905, at the age of 3 years and 8

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... hs, when a diagnosis of cretinism was made on a history that she did not walk nor talk and on the presence of coarse, thick hair, an open mouth, a lolling tongue, short thick thighs, a fontanel of 1\m=1/2\by 1\m=1/2\inches and a weight of 27\m=1/2\ pounds. Given thyroid in small doses, she gained rapidly and steadily in weight and height and intelligence. In seven months she was walking and talking and was regarded as very mischievous. At the end of two years' treatment she was bright and intelligent with a closed fontanel and a not greatly protuberant abdomen. Enuresis was noted toward the end of this period. Shortly after this it was noted that she was not so bright and the dose of thyroid was increased somewhat. She wet the bed a good deal and her skin had a tendency to break out and to be rough. Still she made good progress in weight and height, reaching 45% inches at 8 years (January, 1910) and 56V2 pounds. At this time she came under the direct charge of an assistant who was an enthusiast who regarded her slowness in mental progress as an evidence that she needed more thyroid, and who proceeded to increase her dose successively from 3 grains a day, the maximum up to then, to 4, 6, 9, 10 and even 15 grains of B. W. & Co. thyroid a day. She had 10 grains a day during the entire year 1912. This increase of thyroid was not productive of mental improvement, and it did result in an immediate loss in weight and a subsequent development of signs of hyperthyroidism already foreshadowed, perhaps in the enuresis and tendency to rashes, particularly scabs about the nose. She became nervous, irritable, of a poor memory, wet the bed every night and the mentality became even duller. When she came under my direct care in February, 1913, she was 11 years old, a large child, a little shorter than the average, and a little above average weight. She was dull in school and could not pay attention. She wet the bed every night. She was very nervous and irritable, and had an ugly temper. Her ner¬ vousness had reached such a degree as to amount to a positive tremor which had been suspected to be chorea. This prevented her using pen and ink. Her appe¬ tite was excessive-she ate all the food that she could lay her hands on-one morning she ate eight rolls for her breakfast. Her pulse was 120. There was no heart murmur. She weighed 73 pounds and measured in height 53V3 inches in stockings.