the meeting was called to order by Dr. H. J. Rowe of Willow Springs. Those present were Drs. Elliott, Shuttee, Rowe, Black, Bess, Bingham, Hendrix, Weusthoff and Thornburgh. The minutes of the previous meeting were read and approved.

Dr. A. H. Thornburgh read a paper on secondary infections, in which he called attention to the many and varied conditions that may arise during or after the cessation of a primary infection. He gave an extended list of the complications met with during the course of the commoner diseases. The paper was liberally discussed by the members present.

Dr. H. C. Shuttee, President of the State Medical Association, was present and gave a very interesting address. During the course of his remarks he described his trip to the meeting of the American Medical Association at Atlantic City in June. This address was full of interesting and instructive incidents, and made it apparent that every member of the Association ought to bend every effort to attend the meetings.

Dr. James H. Elliott, councilor for this district and delegate to the State Medical Association meeting held at Joplin in June, made his report. He said the by-laws of the State Association had been amended so that the House of Delegates would meet the first day of the annual session and complete its work at that time. This will allow delegates to attend the scientific sessions during the remainder of each meeting. The by-law providing for the defense of members against malpractice suits was amended so that the committee shall not expend more than $100 on any one case. This was done on the recommendation of the Defense Committee, it having reported a rapid growth in the number of suits and a marked increase in the expense attached. The Defense Committee reported that its usefulness to the members was far greater from the moral standpoint than from the monetary viewpoint.

The by-law providing for orators on medicine and surgery was rescinded and the election of president was made to occur in the House of Delegates instead of at the general session on the last day of the meeting. The object of putting all this legislative work in the House of Delegates was for the purpose of increasing the importance of the scientific work and permitting a larger attendance at the scientific sessions.

The highest honor within the gift of the profession was conferred on the Howell County Medical Society by the choice of one of its most respected and beloved members, Dr. H. C. Shuttee, for President. Dr. Elliott described the short but earnest campaign he waged in Dr. Shuttee's behalf when he learned after the meeting commenced that the President would be chosen this year from the members outside of the large cities. He expressed supreme gratification with the attitude of the members toward Dr. Shuttee's candidacy and their faith and confidence in him and for the splendid support accorded him for the honor. He said Dr. Shuttee did not know his name was under consideration for this high honor and was quite unaware of his election until Dr. Elliott greeted him with the welcome tidings, "Mr. President."

The Howell County Medical Society certainly appreciates this great honor, and feels under many obligations to its energetic delegate, Dr. Elliott, and his friends who labored so untiringly to bring this coveted honor to our district.

Knowing Dr. Shuttee as we know him, we are sure he will fill the chair with honor to himself and credit to this section of the state, and by his energy and labor will do much to strengthen the Missouri State Medical Association. A. H. THORNBURGH, M.D., Secretary.

JOHNSON COUNTY MEDICAL SOCIETY The Johnson County Medical Society met in regulat session Tuesday, September 8, in the Court Room of the Court House.

Dr. M. P. Shy of Sedalia, formerly of Knobnoster, and a member of our society, read a paper on the subject, "Tic Douloureux and Its Treatment by Deep Injections of Alcohol."

The society took up the question of medical inspection of schoolchildren with the result that a plan was partially inaugurated whereby the schoolchildren of Johnson county may receive gratuitous medical inspection. This is a step which has been long contemplated by the pedagogical and, medical fraternities of the county and we believe is a forward movement in the economic and scientific achievement of the community.

Last month the society voted to hold monthly meetings. The interest which the members display in the purposes of the society seems to prove that frequent meetings serve as a constant reminder that "something is doing"; a most needed attribute in the progress of a county medical society.

Business, of much importance to the medical fraternity is pending further action and will be well worth reporting later.

We have found that live problems must be kept constantly before the members to make a live society. An organization must always have a "job"-something to do and those enterprises must be worthy of the consideration of the membership.

O. B. HALL, M.D., Secretary.

JOINT MEETING OF KNOX AND SCOTLAND COUNTY MEDICAL SOCIETIES

A joint meeting of the Knox and Scotland County Medical Societies was held in the Hotel Baring, Baring, on Tuesday, August 4. Dr. G. S. Brown, President Knox County Medical Society, presiding. Members present were, Drs. Geo. S. Brown, H. H. St. John, H. J. Jurgens, J. Keaney, F. E. Luman, Wallace Petty, J. W. Petty, E. E. Parrish, A. L. Davis, P. M. Baker, A. E. Platter, Fred. Reilley, H. E. Bullock, J. L. Statler, G. F. Forster, J. W. Haden. The following papers were read: "Infantile Diarrhea," by Dr. F. E. Luman, Baring; "Cholera Infantum," by Dr. James Keaney, Edina; "The Perineum and Its Difficulties," by Dr. A. E. Platter, Memphis; "Uremic Poisoning," by Dr. P. M. Baker, Memphis; "Pick-Ups in Typhoid Therapy," by Dr. E. E. Parrish, Memphis; "Fractures of the Humerus," by Dr. H. J. Jurgens, Edina. These papers were all thoroughly discussed by the members present.

Dr. J. W. Haden of Plevna presented a very interesting clinic which proved to be a case of brain tumor, of either luetic or tubercular origin.

It was decided to hold another joint meeting at Rutledge on September 10.

H. J. JURGENS, M.D., Secretary.

LAWRENCE-STONE COUNTY MEDICAL

SOCIETY

The Lawrence-Stone County Medical Society met at Aurora, Sept. 1, 1914. The meeting was called to order at 10 a. m. by the president, Dr. H. L. Kerr. The following physicians were present: Drs. F. S. Stevenson, C. A. Moore, D. C. Adams, T. D. Miller, R. C. Robertson, J. P. Andrews, W. S. Loveland, J. W. Smith, H. L. Kerr, L. Henson, L. S. Shumate, J. A. Melton. Visitors: Drs. H. A. Lowe, C. W. Rus

sell, M. C. Stone, C. E. Fulton and E. C. Roseberry of Springfield.

The regular program was not taken up at the morning session. The time was taken up with case reports from several of the members present.

At 11:30 the society adjourned for lunch and met again at 1 o'clock when the following program was rendered:

"Appendicitis," Dr. C. W. Russell, Springfield; "Nephritis in Pregnancy, with Report of case,” Dr. F. S. Stevenson, Aurora; "Report of a Case of Amebic Dysentery," Dr. R. C. Robertson, Aurora; "What Is the Legitimate Relation of the Physician to the Patient," Dr. J. P. Andrews, Marionville. The society adjourned to meet at Aurora, Dec. 1, 1914. R. C. ROBERTSON, M. D., Secretary.

PIKE COUNTY MEDICAL SOCIETY The Pike County Medical Society held its regular monthly meeting in the office of Dr. J. E. Bankhead at Clarksville, Monday, September 7. The following members were present: Drs. C. L. Bankhead and R. J. Guy of Paynesville; Drs. T. Guy Hetherlin and J. W. Dreyfus of Louisiana; Drs. J. E. Bankhead and E. M. Bartlett of Clarksville and Dr. F. V. Keeling of Elsberry.

The president, Dr. E. M. Bartlett, read a very interesting paper on "Infantile Convulsions," which brought forth a general discussion.

Several interesting cases were reported and dis

cussed.

Dr. J. E. Bankhead, Dr. D. M. Pearson and Dr. C. E. Gibbs were appointed a committee to appear before the county court at their next meeting and ask for free toll for the doctors of the Pike County Medical Society in view of the fact that the members of the society do an immense amount of charity work that would fall as a burden on the county were it not for the charitableness of the profession. The meeting adjourned to meet in Louisiana, October 5. F. V. KEELING, M.D., Secretary.

POLK COUNTY MEDICAL SOCIETY The Polk County Medical Society met at the Cary Hotel at Bolivar at 11:30 a. m., September 8, and was called to order by the president. The following physicians answered to roll call: Drs. R. Lee Russell, R. W. Paris, A. J. Stufflebam, R. D. Dill, L. L. Hunt, A. P. Mitchell, W. G. Drake, J. E. Loafman, C. N. Hahn, W. D. Drake and J. F. Roberts, also Dr. Rosco C. Nevins of Flemington; and visitors, Drs. S. A. Johnson, T. O. Klingner and G. W. Barnes of Springfield.

The minutes of the last meeting were read and approved.

The Board of Censors reported favorably on the application for membership of Dr. D. E. Hammontree of Half Way, who was on motion voted a member of the Polk County Medical Society.

Dr. T. O. Klingner, district councilor of Springfield, delivered a very interesting address on "The County Medical Society."

Dr. C. N. Hahn and Drs. A. J. Stafflebam reported cases to the society.

Dr. L. L. Hunt reported a case of tuberculosis of lungs with treatment, and also one of double pleural effusion with treatment, which were discussed.

The society, after adjourning an hour for dinner, reconvened at 2 p. m.

On motion, Drs. T. O. Klingner and G. W. Barnes from the Greene County Medical Society, were elected honorary members of the Polk County Medical Society.

Dr. R. C. Nevins, a member of the Hickory County Medical Society, but now of Flemington, Polk County, made written application by transfer for membership in Polk County Medical Society.

Dr. S. A. Johnson read a very interesting paper on "Eugenics and Heredity in Mental and Nervous Diseases," which was discussed by all present.

It was moved and carried that Polk County Medical Society invite Dallas County to join with them until such time as Dallas County can organize a society of its own.

On motion the society adjourned to meet again at Bolivar on the second Tuesday in December.

J. F. ROBERTS, M.D., Secretary.

RALLS COUNTY MEDICAL SOCIETY The Ralls County Medical Society met in regular session at Spalding Springs, August 27, where a beautiful day, a splendid dinner, a pleasant outing and a good program greeted the members and visitors. Doctors from Marion, Monroe and Pike counties were in attendance and at least one hundred and fifty Ralls County citizens met with us. Among those in attendance were Drs. E. H. Bounds, William H. Hays, John J. Farrell and R. M. Winn of Hannibal; Dr. T. Guy Hetherlin of Louisiana; Drs. W. S. Harwood, J. N. Southern and W. T. Rutledge of Monroe City, while little Ralls was represented by Dr. H. B. Norton of Center, Dr. W. T. Waters, Col. Joe Burnett, editor The Ralls County Record, and Dr. T. J. Downing of New London.

Dr. T. Guy Hetherlin read a paper on "Eclampsia.” Both the laity and the profession gave the doctor undivided attention while reading his paper.

Dr. H. B. Norton read a splendid paper on "Vaccine and Serum Therapy as a Rational Treatment of Disease."

Dr. R. M. Winn read a paper on "Care of the Special Senses of Children." There being so many of the laity present, Dr. Winn's paper should accomplish great good.

The paper of Col. Joe Burnett was the success of the evening.

"The Duffield Method of Resuscitation of the NewBorn" was clearly demonstrated by Dr. T. Guy Hetherlin.

Dr. T. J. Downing gave a report of three cases of inoperable cancer of the uterus, unsuspected by the patient and family and discovered only when the doctor was called.

This was a most enthusiastic and successful meeting. Every paper was fully discussed and every doctor took an active part.

We have elected Col. Joe Burnett an honorary member of the Ralls County Medical Society. We believe that a local editor in the county society would mean much in the bringing together of the laity and organized medicine.

T. J. DOWNING, M.D., Secretary.

THE TRUTH ABOUT MEDICINES

NEW AND NONOFFICIAL REMEDIES Since publication of New and Nonofficial Remedies, 1914, and in addition to those previously reported, the following articles have been accepted by the Council on Pharmacy and Chemistry of the American Medical Association for inclusion with "New and Nonofficial Remedies."

HEPCO FLOUR.-A flour prepared from the Soya bean. It is claimed that clinical trial has shown that the small percentage of carbohydrates in Hepco Flour is in the main not sugar-producing, and that it therefore is a suitable food material in cases in which carbohydrates are contra-indicated, as in diabetes, amylaceous dyspepsia, etc. Hepco Flour is also sold in the form of biscuits as Hepco Dodgers and a granulated "breakfast food" as Hepco Grits. Waukesha Health Products Company, Waukesha, Wis. (Jour. A. M. A., Sept. 26, 1914, p. 1113).

PROPAGANDA FOR REFORM

DIGALEN OMITTED FROM N. N. R.-In view of increased extravagance regarding the claims made for Digalen by the Hoffmann-La Roche Chemical Works the Council on Pharmacy and Chemistry decided to investigate the present eligibility of Digalen. Examination demonstrated that the asserted presence in Digalen of "amorphous digitoxin" was not substantiated by evidence, that Digalen and Digalen Tablets were not constant in composition and action and that the claim that Digalen causes less gastric disturbances than digitoxin was unfounded. While the manufacturer promised to hold the claim that Digalen contained "amorphous digitoxin" in abeyance, they refused to concede the variable composition of Digalen and reasserted that Digalen was less liable to cause gastric irritation than other digitalis preparations. In view of the overwhelming evidence that Digalen is variable in action and in composition and that it produces the same gastric disturbances as other digitalis preparations, the Council voted that Digalen and Digalen Tablets be omitted from N. N. R. (Jour. A. M. A., Sept. 5, 1914, p. 881).

DOSE OF DIPHTHERIA ANTITOXIN.-While 3,000 units, the dose given in the Pharmacopoeia, probably is a sufficient initial dose in many cases, this quantity is not enough to satisfy the factor of safety. There is a growing opinion that no case of diphtheria should receive less than 10,000 units as the initial dose (Jour. A. M. A., Sept. 5, 1914, p. 873).

VACCINATION AGAINST SMALL-POX AND TYPHOID.— In view of the war, a general revaccination of the population of Paris has been ordered and huge quantities of antityphoid serum have been prepared (Jour. A. M. A., Sept. 5, 1914, p. 873).

ANGIER'S EMULSION.—A report of the Council on Pharmacy and Chemistry points out that when Angier's Emulsion, Angier Chemical Co., Boston, Mass., was first put on the market it was advertised as a "food-medicine" and an "Ideal Substitute for Cod Liver Oil." Although the manufacturers now advertise this product as a laxative and state it to be "purely mechanical in its action" they still mingle with the new ones the old claims of "tonic and reconstructive merits" and thus attempt to perpetuate the erroneous belief that the preparation has nutritive value. As to the identity of the petroleum product contained in the preparation, regarding which the advertising circulars make contradictory statements, the American Medical Association Chemical Laboratory reports that this has all the properties of soft yellow petrolatum (Jour. A. M. A., Sept. 12, 1914, p. 962).

ANGIER'S THROAT TABLETS.-These tablets are stated to be composed essentially of elm bark and petroleum and yet are claimed to "promote appetite and aid digestion." The American Medical Association Chemical Laboratory reports the tablets to contain about 12 per cent. of soft yellow petrolatum, like that found in Angier's Emulsion (Jour. A. M. A., Sept. 12, 1914, p. 964).

ANTISEPTIC ACTION OF HEXAMETHYLENAMIN.-The former opinion that hexamethylenamin possesses antiseptic action independently of the liberation of formaldehyd, was an assumption not founded on reliable experimental evidence. The recent investigations of Burnam, Hanzlik and others have shown that its action as an antiseptic depends on the decomposition into formaldehyd and ammonia which occurs only in an acid medium (Jour. A. M. A., Sept. 12, 1914, p. 962).

VACCINE VIRUS NOT CONTAMINATED.-A study of cases shows that vaccinal tetanus is not due to contaminated vaccine virus. Further, since the law regulating the sale of biologic products in 1902 went into effect, there have been examined in the Hygienic Laboratory of the U. S. Public Health Service over 1,500,000 doses of vaccine virus without a single specimen having been found to contain tetanus spores. Also, experiments indicate that tetanus will not be produced even if the virus used contains tetanus spores. Most cases of vaccinal tetanus are due to infection after vaccination (Jour. A. M. A., Sept. 19, 1914, p. 1032).

SODIUM VERSUS POTASSIUM SALTS.-The probable shortage of potassium salts due to the war suggests that sodium salts may in most cases be substituted without disadvantage. In general potassium salts have no marked superiority over the corresponding scdium salts. While the potassium compounds are said to be more active and to possess a more diuretic effect, the sodium salts are less depressing to the heart and in some instances less disagreeable to the taste. Sodium iodid, sodium bromid, sodium acetate, sodium citrate, etc., are just as effective as the corresponding potassium salts (Jour. A. M. A., Sept. 19, 1914, p. 1034).

SANATOGEN.-Testimonials for Sanatogen are published which show good results in cerebral concussion, alcoholic gastritis, anemia, etc. The patient is given a chance to recover by rest, a proper diet and Sanatogen and the recovery is attributed to Sanatogen. Based on some biologic experiments the exploiters of Sanatogen assert that "Sanatogen acts as a strong stimulus as far as the recuperative powers of the blood are concerned." These experiments were repeated by Prof. A. J. Carlson of the University of Chicago, using Sanatogen, casein, casein and glycerophosphates, milk, and crackers and milk. Professor Carlson's experiments show that the effects produced by Sanatogen are not different from those obtained when casein, casein and glycerophosphates, milk, and crackers and milk are used (Jour. A. M. A., Sept. 26, 1914, p. 1127).

VALUE OF TALCUM POWDERS.-The action of talcum powders on the skin depends on their protective and dehydrating properties. On the other hand they tend to form crusts and pastes, due to mixture of the powder with sweat or other secretions. There is doubt if the boric acid in talcum powders can exert

any antiseptic action. The action of the salicylated talcum powder of the National Formulary, though containing 10 per cent. of boric acid, depends on its salicylic acid. Commercial talcum powders contain small amounts of various antiseptics and perfuming agents and have little value from a therapeutic point of view (Jour. A. M. A., Sept. 26, 1914, p. 1129).

LIQUID SOAP.-The following economical formula has been proposed. It may be flavored and colored to suit: Sodium hydroxid 55 gm., potassium hydroxid 65 gm., cottonseed oil 800 c.c., alcohol 500 c.c. and water to make 5,000 c.c. (Jour. A. M. A., Sept. 26, 1914, p. 1129).

SIGNIFICANCE OF THE WORD "LUTEIN."-The word "Lutein" has long been applied in physiologic chemistry to designate a group of fat-coloring matters which occur in nature and which have more recently also been given the general designation of lipochromes. As a rule the use of the term has been restricted to the yellow coloring-matter which develops in the ovarian structures. It is unfortunate that lately various preparations of desiccated corpora lutea from animals are being sold as lutein (Jour. A. M. A. Sept. 26, 1914, p. 1119).

BOOK REVIEWS

BEDSIDE HAEMATOLOGY. An introduction to the clinical study of the so-called blood diseases and of allied disorders. By Gordon R. Ward, M.D., Fellow Royal Society of Medicine, London, etc. Illustrated, pp. 394, W. B. Saunders Co., Philadelphia and London, 1914.

The volume before us fills a long felt want in medical literature. Pathological investigation of "blood diseases" has overshadowed "bedside" study of these diseases and it is with the clinical aspects of the subject that the volume is concerned.

MODERN SURGERY, GENERAL AND OPERATIVE. By John Chalmers Dacosta, M.D., LL.D., and Samuel D. Gross, Professor of Surgery, Jefferson Medical College, Philadelphia, etc., seventh edition, revised, enlarged and reset, with 1,085 illustrations, pp. 1,515. W. B. Saunders Co., Philadelphia and London, 1914.

Dacosta's surgery is one of the living classics of medicine. The seventh edition amply fulfils the high requirements set by former editors; the text has been reset, many new illustrations have been added and the whole has been brought up-to-date.

TEN SEX TALKS TO BOYS (10 years and older). By Irving David Steinhardt, M.D., illustrated, pp. 187. J. B. Lippincott Co., Philadelphia and London, 1914. TEN SEX TALKS TO GIRLS (10 years and older) by Irving David Steinhardt, M.D., illustrated, pp. 193. J. B. Lippincott Co., Philadelphia and London, 1914. The difficulties that lie in the way of an approach to the subject embraced by the two volumes announced above are universally recognized. Of all the books upon the subject which we have seen, the two books by Dr. Steinhardt are the sanest by far.

INFANT FEEDING. By Clifford G. Grulee, A.M., M.D., Assistant Professor of Pediatrics at Rush Medical College, Chief of Pediatric Staff, Cook County Hospital. Second edition, thoroughly revised. Octavo of 314 pages, illustrated. Philadelphia and London: W. B. Saunders Company, 1914. Cloth, $3 net.

In this second edition the author has taken advantage of the helpful criticisms bestowed upon the first by critics. The scientific data, which is the fruit of the past two years, has been embodied in the work, which is now one of the few really worth while volumes on the subject extant.

PROGRESSIVE MEDICINE. A quarterly digest of advances, discoveries and improvements in medical and surgical sciences, edited by Hobart Amory Hare, M.D., and Leighton F. Appleman, M.D. Octavo of 339 pages, illustrated. Philadelphia and New York: Lea and Febiger, 1914. Price per year, paper, $6. The subjects effectively treated in the September number are: Diseases of the Thorax and its Viscera, including the Heart, Lungs and Bloodvessels, by William Ewart, M.D., F.R.C.P.; Dermatology and Syphilis, by William S. Gottheil, M.D.; Obstetrics, by Edward P. Davis, M.D., and Diseases of the Nervous System, by William G. Spiller, M.D. MODERN MEDICINE: ITS THEORY AND PRACTICE IN ORIGINAL CONTRIBUTIONS BY AMERICAN AND FOREIGN AUTHORS. Edited by Sir William Osler, Bart., M.D., F.R.S., and Thomas McCrae, M.D. Vol. ii, second edition, thoroughly revised. Illustrated. Lea & Febiger, Philadelphia and New York, 1914. The profession will be glad to welcome a second edition of volume two of Modern Medicine, which comes out, as its predecessor appeared, under such brilliant auspices. The work is divided into six parts: Protozoan infections; diseases caused by animal parasites; diseases caused by physical agents; diseases due to chemical and organic agents; diseases of metabolism and diseases of the respiratory tract. PRACTICE OF SURGERY. By James Gregory Mumford, M.D., with 683 illustrations. Second edition, thoroughly revised. W. B. Saunders Company, 1914, Philadelphia and London.

This comprehensive and extensive work which was so generously received by the profession in its first edition, is brought wholly up to the present-day methods of acceptable surgery. Proceeding upon the basis that a general surgeon is well grounded in his practice, the author has not attempted, he says, "to deal comprehensively, accurately and skillfully with all branches of surgery." He has, therefore, given an account of surgery as it is seen at the bed-side, in the accident ward and in the operating room, so that the student will find a practical description of all general surgical ailments that he might be required to alleviate.

The book is written in a somewhat unconventional manner as regards the order in which subjects are discussed. Dr. Mumford has presented these subjects in their order of interest, importance and frequency, hoping that by such a plan he could present the subjects in their true perspective.

ORIGINAL ARTICLES

PUBLICATION

STATUS LYMPHATICUS AND STATUS HYPOPLASTICUS AND THEIR RELATIONSHIP ΤΟ THE GLANDS OF INTERNAL SECRETION *

W. W. DUKE, PH.B., M.D.

KANSAS CITY, MO.

Status lymphaticus and status hypoplasticus are rarely considered in general medical practice and yet they represent very common conditions and their recognition is often of value in the diagnosis and prognosis of other diseases with which a patient may be afflicted. As I reflect over conversations concerning cases which I have seen with older men of broad experience, I cannot help believing that the diagnosis and prognosis which they have based occasionally on what they proudly termed "intuition" has in reality been based on an unconscious observation of various lymphatic or hypoplastic stigmata of which I shall speak. It is evident that any grouping or classification of such stigmata which would enable men of less experience to recognize and interpret them scientifically would be a valuable addition to our knowledge.

A very important contribution to our knowledge of the subject has recently been made by Julius Bartel. While making a histologic study of the lymph-glands in status lymphaticus, Bartel noted an increase in the connective tissue stroma of the glands in addition to the general hyperplasia of lymphoid elements which gives rise to the general enlargement. The change in the stroma is discernable in infancy; and gradually increases with age, the rate of increase appearing to be most rapid at or soon after puberty. At this time the lymphatic elements usually diminish in number and often the glands decrease in size. This condition has

*Read in the General Session of the Missouri State Medical Association, at the Fifty-Seventh Annual Meeting, held at Joplin, May 12-14, 1914.

Number 5

W.H BREUER, M.D., Chairman COMMITTEE M. A. BLISS, M.D. S. P. CHILD, M.D.

been termed an atrophic stage of status lymphaticus. It was noticed further that the proliferated connective tissue was not scattered irregularly throughout the gland, but lay chiefly along the course of the blood-vessels. This constitutes an architecture which Bartel considers characteristic of the disease. Histologic pictures which Bartel and others believe analogous to this have been found in the thymus by Kyrle; in the ovaries by Bartel and Hermann, and in the adrenals of two young individuals presenting signs of status lymphaticus by Wiesel. Neusser mentions having noticed frequently a combination of status lymphaticus with cirrhotic processes and polyserositis of non-tuberculous origin. From these observations and also from the frequent occurrence of hypoplastic stigmata in lymphatic individuals, Bartel, Neusser and others have been led to believe that status lymphaticus is in reality not a disease in itself, but rather may be looked on as part of a generalized hypoplastic constitution of status hypoplasticus. It has been suggested, and I think with reason, that in individuals with the so-called hypoplastic constitution there exists a congenital or early acquired weakness of the parenchymatous elements in the body which tends to cause their early atrophy and replacement with connective tissue. It is certain that their tissues do not stand the strain of life as well as others, and the development and symptoms of the patients suggest faulty activity of various organs of internal secretion.

It is not my purpose in this paper to discuss at length the pathology of the glands of internal secretion. I should like, however, to illustrate by a few well-known examples the profound body principally for the purpose of convincing influence which these glands may have on the you that the smaller and more generalized involvement which is so frequently observed in status hypoplasticus is worthy of serious consideration. First I should like to call attention to the difference in size between a well-known type of dwarf whose deformity is a consequence of partial destruction of the pituitary