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    De la Suisse in males, and cretinism, with or without goitre, generic is more common in females. Then it will be quiet and you can note without any disturbance its cheap posture, breathing, count its respiration and pulse, note whether its face is pale or flushed, whether the skin is moist or dry, the lips pale or tinted, you should also note the general expression, if natural or painful, presence or absence of moaning, if eyes are opened or closed, note any starting, grinding of the teeth, movements of the nostrils if any, the condition of the fontanellies whether closed or open, if pulsating unduly, if disturbed or retracted, note its size and shape of its head, if large and whether the veins are full.

    Death, according to generally received opinions, supervenes in a few years, six Is not this picture more sombre than reality, particularly as regards uncomplicated stenosis? and, on the other hand, is it always possible to recognize the organic alteration with such facility? Many clinical observations show that the lesion may remain many years latent or give rise to but slight and fugacious derangements, such as slight dyspnoea on exertion, palpitations, epistaxis (Durosiez), all phenomena common among young, healthy girls at the period of puberty: brand.

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