There are cases, however, in which the arrest of development is not to be attributed to some wasting disease, or to the denutrition resulting from it; but rather to some acute illness occurring in early childhood (pneumonia, etc.), after which the child ceased to progress in accordance with his former obviously normal development.

Anangioplastic Infantilism.—Another form of infantilism is associated with a malformation of the heart and blood-vessels, that is to say, the heart and aorta together with the entire circulatory system are of small dimensions; the calibre of the arteries is less than normal. In such a case the restriction of the entire vascular system and the scantiness of circulation of the blood constitute an impediment to the normal growth of the organism. Although in such cases the explanation of the cause of the phenomenon is purely mechanical, nevertheless such abnormality of the heart and veins is to be classed as a teratological (monstrous) malformation, determined by original anomalies of the ductless glands, similar to what is found in cases of cephalic and cerebral monstrosities.

In this form of infantilism the patient shows not only the usual fundamental characteristics already noted, but also symptoms of anemia as obstinate to all methods of treatment as chlorosis is; in addition to which they often show congenital malformations of the heart, in every way similar in their effects to valvular affections such as may result from pathological causes (chief of which are mitral and aortic stenosis, which consist of a stricture of the valves connected with the left ventricle of the heart).

Accordingly, children who show forms of mitral infantilism are inferior to their actual age not only in their whole psychosomatic appearance, but they are noticeably weak, pale and suffering from shortness of breath and disturbances of the circulation. In such cases, neither pedagogy nor hygiene can counteract the arrest of development; but it is well that the attention of teachers should be called to such cases, in order that cruel errors may be prevented, which would unconsciously do additional harm to individuals already burdened by nature with physiological wretchedness.

In conclusion: The normal growth of the organism is associated with the functional action of certain glands known as glands "of internal secretion," such as the thymus and thyroid, first of all, as well as the suprarenal capsules and the cerebral hypophysis.

This group of formative glands presides not only over the entire growth of the body, but also over the intimate modeling of its structure; so that a lesion or deficiency in any of them results not only in nanism and an arrest of mental development, but in various forms of general dystrophy.

That the organism is associated in the course of its transformations with the functional action of specific glands is shown by the development of puberty, which consists in a series of transformations of the entire organism, but is associated with the establishment of functional activity of glands that were hitherto immature: the genital glands (ovaries, testicles). These glands also are functionally in close sympathy with the entire group of formative glands: so much so that, if the glands of internal secretion are injured, the genital glands usually fail to attain normal development (infantilism). Now, the transformations which take place in the organism at the period of puberty might be produced at other periods if the functional action of the generative glands should show itself at a different epoch. That is, these transformations are not associated with the age of the organism, but with the development of specific glands. There are cases of the genital glands maturing at abnormal ages; or of local maladies that have hastened the appearance of the phenomena of puberty in children of tender years. A notable case is that described by Dr. Sacchi,[32] of a nine-year old boy, who had grown normally up to the age of five and a half, both in his physiological organism and in his psychic personality. At the age of five and a half, the child's father noticed a physical and moral alteration; the child's voice grew deeper, his character more serious, and the skeletal and muscular systems grew rapidly, while on certain portions of the body, as for example on the face, a fine down appeared. At the age of seven the child had attained a stature that was gigantic for his age; he was very diligent and studious and did not care to play with his comrades. At nine, he had a stature of 1.45 metres (the normal stature being 1.22), a weight of 44 kilograms (normal = 24); his muscles were highly developed, his powers of traction and compression being equal to those of a man; his chin was covered with a thick beard five centimetres long. When he was examined by a physician, the latter discovered a tumor in the left testicle. After an operation, the child lost his beard and regained his childish voice; his character became more timid and sensitive; he began once more to enjoy his comrades and take part in boyish games. His muscular force underwent a notable diminution.

Rickets.—It is important not to confound any of the various forms of infantilism with rickets. Rickets is a well-defined malady whose special point of attack is the osseous system in course of formation; but it leaves the nervous system and the genital system unimpaired. The sufferer from rickets may be a person of intelligence, capable of attaining the highest distinctions in art or in politics; he is normal in his genital powers, so that he is capable of normal reproduction, without, in many cases, transmitting any taint of rickets to his descendants.

Nevertheless this disease, like all constitutional maladies, occurs only in individuals who are weakly.