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Some factors that inhibit and accelerate growth in children
SOME FACTORS THAT INHIBIT AND ACCELERATE GROWTH IN CHILDREN· By BENJAMIN BASHINSKI, M.D., MACON, GA.
MANY factors accelerate and inhibit growth in children, and chief among these are the pineal or pituitary gland and the thyroid gland. In pineal tumors we find an abnormal development and an associated sexual precocity. The experimental removal of the pituitary will cause a deposition of fat and a persistence of deciduous dentition. Changes in the form and size of the teeth are caused by the influence of disturbance of the pituitary gland, associated with disturbance of the thyroid gland. The pituitary body is composed of three parts, the anterior lobe, the intermediate portion and the posterior lobe, the anterior being glandular in construction; the intermediate, which as a rule is grouped with the posterior, is nerve tissue in origin. Tissue growth, especially the skeleton, is associated with the anterior lobe. An overactive anterior lobe will cause a most marked change the bones. H. Gardiner Hill and J. Forest Smith reported the effects of feeding extracts of the anterior lobe of the pituitary to children. The observations extended over a period of one year. In cases of infantilism, where the epiphyses are not already fused, these extracts appear of value in influencing growth. In a deficiency of the thyroid hormone, skeletal changes are usually marked and set in very early. The long bone shafts show narrowing. The skull is thickened and the entire facial bones are undeveloped, producing a saddle nose and prominent forehead. The mandible is gracile, the milk teeth appear late and may be persistent, the permanent teeth are small, are located abnormally, decay early and erupt late. The bony development and epiphyseal closures are far below the normal. If the thyroid gland is injured in any way during childhood so that the secretion is diminished, there will be delay in growth as well as in mental development. Doctor Barker describes the symptoms very clearly when the parathyroid glands are removed or made insufficient in function by disease. Tetany develops with its tonic spasms. In chronic cases profound disturbance of nutrition manifests itself as alterations in the enamel of the teeth (little black lines of enamel defect run parallel to each other across the teeth). Patients are irritable and tire easily. Doctor Barker also states" that, though the role of internal secretions in growth and development is undoubtedly very important, the subject is so
in
1929. "Read before the Southern Soclety of Orthodontists at Macon, Ga., Jan. 31, Feb. 1 and 2,
1065
1066
Benjamin Ba-shi'l1-ski
extremely complex and the interrelationship of the glands is so little understood that as yet we can do little more than guess as to the exact disturbances that may be responsible for individual types." Hyperplastic adenoid tis sue leads to nasal obstruction and other clinical manifestations. In older chi ldr en hypertrophic adenoids lead to mouth-breathing and faulty configuration of the face. Obstruction to respiration will cause a thoracic deformity due to a great strain upon the diaphragm and an associated retardation in gen eral growth. Inheritance plays a most important factor in the acc eleration and inhibition of growth in children. Dr. Clarence C. Little quotes Davenport in 1917 on inheritance of stature in man. Among his general conclusions are the following: The offspring of two tall parents are less variable in stature than those of two short parents. When both parents ar e tall or very tall practically all of the children are tall or very tall. When both parents are very short or short and of short stock, all children are short or very short. Short parents may and frequently do carry germ cells which lack the shortening factors, while in tall parents the gametes are more n early homogeneous and all lack most of the shortening factors . Some symptoms of nervousness are very often accompanied by faults in the physical development of the child. Defects assume man y forms . Some nervous children are marked by a persistence in later childhood of certain infantile characteristics of the build and shape of the body. We see the rheumatic type of child, with chorea, 01' a child that is listless. Again, we meet with hysteria. In the nervous syste m conditions are different from those we find in the muscular system. W e find in skin, bone and mus cle new cell elements constantly being formed. The lif e of the individual cell is relatively short. On the other hand, in the nervous system the individual cells are long-lived. Many are deprived of cal cium, and this may explain th e increased irritability )f peripheral nerves and a tendency to convulsive seizures of all kinds, as tetany, carpopedal spasm and laryngismus stridulus or child crowing. They lag behind in physical development, are dull at school, sp eak badly and are lacking in coordination. In many nervous children, we find a lack of tone in skeletal muscles, and many of them have a lordosis. Tables of average weight and heght measurements at various ages are tables of averages and are very often misleading. One cannot reasonably expect all children to conform to the figures as giv en us. They differ in height and weight as do adults. Inheritance plays a large part in the height and bu ild. Well-to-do children have more nutritional disturbances than those less financially favored . Growth' involves th e synthesis of a variety of chemical compounds in du e proportion and succession to each other, and this process does not take place with uniform velocity throughout life. The growth of children takes place in spurts. -- Influence of race and environment plays an import.ant part. Robertson states that the intimate dependence of the growth of normal infants upon environment, race and sex at once reveals the fact. that there is no sin gle
An Appreciation of Milo H ellman's Work
1067
standard of infantile development which will be applicable to the average infant of either sex, of differing racial stock or to varying environmental conditions. Robertson also quotes Macgregor who states that the latter half of the first year of extrauterine growth is in r eality a critical period in the development of man. He states that children who fall victims to zymotic diseases during the second half of the first year of extrauterine life, tend to be of markedly subnormal weight before any loss of weight due to the disease itself has occurred; and the incidence of measles, whooping-cough and scarlet fever 1 eaches a maximum at the eighth and ninth months, while diphtheria and cerebrospinal meningitis, although occurring rarely during the first year. show a maximum at the sixteenth and seventeenth months. REFEREl'CES
Janney, Nelson W.: Abt's P ediatrics. Robertson, T. Brailsford: Abt's Pediatrics. Morse: Clinical Pediatrics. Hill and Smith: Practical Medi cine Series 1926. Little, Clarence C.: A bt'8 Pediatrics. Barker, Lewellys F.: Reprint Hospital Social Service, 1928 . Cameron, H. C.: The N erY0l18 Child.
AN APPRECIATION OF l\IILO HEI.JLMAN'S WORK!! By
'VIIJLIAM
K.
GREGORY ,
PH.D. ,
NEW YORK
TO
WRITE an obituary notice of a great man who is dead is a sad duty, to write a biographie note of one who is just entering the highest plateau of middle life is both a privilege and a pleasure. As I look over the long file of Hellman 's papers, I am impressed by his extraordinary patient and persistent search for fundam ental facts and principles in the study of occlusion and malocclusion. The genesis and development of his leading ideas would form an interesting chapter in the history of the science of orthodontia. Ill' came into the field of dentistry from an unusual angle, after having achieved an honorable place in the art of music. In this his hands were trained for delicate manipulations, and his mind was opened to the value of small differences; he learned also how to articulate his own efforts with those of others and how to combine small units into beautiful wholes. All of these qualities have doubtless contributed to his success in the practice of the art of orthodontia, but they are equally discernible in the fruit of his labors in pure science. As a musician, Hellman was oppressed with the dread of the culdesac, and it drove him out to seek a broader field. And as a student of dentistry and finally of orthodontia, he was filled with that form of the devil of unrest which animates the noble army of doubters, heretics, schismatics, inventors, discoverers and other pathfinders of the human spirit. At the same time his "Read before the Southern Soci ety of Orthodontists at Macon, Ga., Jan. 31. Feb. 1 and
2, 1929.
MANY factors accelerate and inhibit growth in children, and chief among these are the pineal or pituitary gland and the thyroid gland. In pineal tumors we find an abnormal development and an associated sexual precocity. The experimental removal of the pituitary will cause a deposition of fat and a persistence of deciduous dentition. Changes in the form and size of the teeth are caused by the influence of disturbance of the pituitary gland, associated with disturbance of the thyroid gland. The pituitary body is composed of three parts, the anterior lobe, the intermediate portion and the posterior lobe, the anterior being glandular in construction; the intermediate, which as a rule is grouped with the posterior, is nerve tissue in origin. Tissue growth, especially the skeleton, is associated with the anterior lobe. An overactive anterior lobe will cause a most marked change the bones. H. Gardiner Hill and J. Forest Smith reported the effects of feeding extracts of the anterior lobe of the pituitary to children. The observations extended over a period of one year. In cases of infantilism, where the epiphyses are not already fused, these extracts appear of value in influencing growth. In a deficiency of the thyroid hormone, skeletal changes are usually marked and set in very early. The long bone shafts show narrowing. The skull is thickened and the entire facial bones are undeveloped, producing a saddle nose and prominent forehead. The mandible is gracile, the milk teeth appear late and may be persistent, the permanent teeth are small, are located abnormally, decay early and erupt late. The bony development and epiphyseal closures are far below the normal. If the thyroid gland is injured in any way during childhood so that the secretion is diminished, there will be delay in growth as well as in mental development. Doctor Barker describes the symptoms very clearly when the parathyroid glands are removed or made insufficient in function by disease. Tetany develops with its tonic spasms. In chronic cases profound disturbance of nutrition manifests itself as alterations in the enamel of the teeth (little black lines of enamel defect run parallel to each other across the teeth). Patients are irritable and tire easily. Doctor Barker also states" that, though the role of internal secretions in growth and development is undoubtedly very important, the subject is so
in
1929. "Read before the Southern Soclety of Orthodontists at Macon, Ga., Jan. 31, Feb. 1 and 2,
1065
1066
Benjamin Ba-shi'l1-ski
extremely complex and the interrelationship of the glands is so little understood that as yet we can do little more than guess as to the exact disturbances that may be responsible for individual types." Hyperplastic adenoid tis sue leads to nasal obstruction and other clinical manifestations. In older chi ldr en hypertrophic adenoids lead to mouth-breathing and faulty configuration of the face. Obstruction to respiration will cause a thoracic deformity due to a great strain upon the diaphragm and an associated retardation in gen eral growth. Inheritance plays a most important factor in the acc eleration and inhibition of growth in children. Dr. Clarence C. Little quotes Davenport in 1917 on inheritance of stature in man. Among his general conclusions are the following: The offspring of two tall parents are less variable in stature than those of two short parents. When both parents ar e tall or very tall practically all of the children are tall or very tall. When both parents are very short or short and of short stock, all children are short or very short. Short parents may and frequently do carry germ cells which lack the shortening factors, while in tall parents the gametes are more n early homogeneous and all lack most of the shortening factors . Some symptoms of nervousness are very often accompanied by faults in the physical development of the child. Defects assume man y forms . Some nervous children are marked by a persistence in later childhood of certain infantile characteristics of the build and shape of the body. We see the rheumatic type of child, with chorea, 01' a child that is listless. Again, we meet with hysteria. In the nervous syste m conditions are different from those we find in the muscular system. W e find in skin, bone and mus cle new cell elements constantly being formed. The lif e of the individual cell is relatively short. On the other hand, in the nervous system the individual cells are long-lived. Many are deprived of cal cium, and this may explain th e increased irritability )f peripheral nerves and a tendency to convulsive seizures of all kinds, as tetany, carpopedal spasm and laryngismus stridulus or child crowing. They lag behind in physical development, are dull at school, sp eak badly and are lacking in coordination. In many nervous children, we find a lack of tone in skeletal muscles, and many of them have a lordosis. Tables of average weight and heght measurements at various ages are tables of averages and are very often misleading. One cannot reasonably expect all children to conform to the figures as giv en us. They differ in height and weight as do adults. Inheritance plays a large part in the height and bu ild. Well-to-do children have more nutritional disturbances than those less financially favored . Growth' involves th e synthesis of a variety of chemical compounds in du e proportion and succession to each other, and this process does not take place with uniform velocity throughout life. The growth of children takes place in spurts. -- Influence of race and environment plays an import.ant part. Robertson states that the intimate dependence of the growth of normal infants upon environment, race and sex at once reveals the fact. that there is no sin gle
An Appreciation of Milo H ellman's Work
1067
standard of infantile development which will be applicable to the average infant of either sex, of differing racial stock or to varying environmental conditions. Robertson also quotes Macgregor who states that the latter half of the first year of extrauterine growth is in r eality a critical period in the development of man. He states that children who fall victims to zymotic diseases during the second half of the first year of extrauterine life, tend to be of markedly subnormal weight before any loss of weight due to the disease itself has occurred; and the incidence of measles, whooping-cough and scarlet fever 1 eaches a maximum at the eighth and ninth months, while diphtheria and cerebrospinal meningitis, although occurring rarely during the first year. show a maximum at the sixteenth and seventeenth months. REFEREl'CES
Janney, Nelson W.: Abt's P ediatrics. Robertson, T. Brailsford: Abt's Pediatrics. Morse: Clinical Pediatrics. Hill and Smith: Practical Medi cine Series 1926. Little, Clarence C.: A bt'8 Pediatrics. Barker, Lewellys F.: Reprint Hospital Social Service, 1928 . Cameron, H. C.: The N erY0l18 Child.
AN APPRECIATION OF l\IILO HEI.JLMAN'S WORK!! By
'VIIJLIAM
K.
GREGORY ,
PH.D. ,
NEW YORK
TO
WRITE an obituary notice of a great man who is dead is a sad duty, to write a biographie note of one who is just entering the highest plateau of middle life is both a privilege and a pleasure. As I look over the long file of Hellman 's papers, I am impressed by his extraordinary patient and persistent search for fundam ental facts and principles in the study of occlusion and malocclusion. The genesis and development of his leading ideas would form an interesting chapter in the history of the science of orthodontia. Ill' came into the field of dentistry from an unusual angle, after having achieved an honorable place in the art of music. In this his hands were trained for delicate manipulations, and his mind was opened to the value of small differences; he learned also how to articulate his own efforts with those of others and how to combine small units into beautiful wholes. All of these qualities have doubtless contributed to his success in the practice of the art of orthodontia, but they are equally discernible in the fruit of his labors in pure science. As a musician, Hellman was oppressed with the dread of the culdesac, and it drove him out to seek a broader field. And as a student of dentistry and finally of orthodontia, he was filled with that form of the devil of unrest which animates the noble army of doubters, heretics, schismatics, inventors, discoverers and other pathfinders of the human spirit. At the same time his "Read before the Southern Soci ety of Orthodontists at Macon, Ga., Jan. 31. Feb. 1 and
2, 1929.