64 THE INTERNAL SECRETIONS 1920 



except the temporal halves of the disc, which are pale ; 

 the visual fields show a right homonymous hemianopsia ; 

 chest negative. Heart : Sounds distant, faint, slow but 

 regular; no murmurs heard; pulse, 60; blood pressure, 

 systolic 182, diastolic 68; arteries showed some harden- 

 ing; abdomen very thick and panniculus; no tender- 

 ness; genitals negative. Extremities: Superficial 

 veins dilated; slight pitting edema of legs; reflexes 

 normal. Examination of skin of the body shows depig- 

 mentation of all areas of over-flapping skin as panni- 

 culus abdomen hangs over upper thighs. Some depig- 

 mentated areas in axilla, surrounded by areas of 

 marked pigmentation, sharply defined; axillary hair 

 almost absent ; pubic hair very scanty ; no hair on fore- 

 arms or legs ; normal growth on head and face. X-ray 

 shows very small and shallow sella turcica which was 

 found to be normal at autopsy. Blood Wasserman 

 negative ; urine negative ; temperature normal. 



Patient continued to have dizzy spells at short inter- 

 vals with total loss of consciousness, and involuntary 

 passing of urine. The pulse became as low as 40 to 50 

 per minute, with some premature systoles. A few days 

 later patient was seized with a series of successive 

 attacks, spastic in nature, with total loss of conscious- 

 ness. His condition grew worse until death. At this 

 time a clinical diagnosis of cerebral thrombosis was 

 made, which later proved to be correct. 



An autopsy revealed arteriosclerosis, thrombosis of 

 the basilar arteries, chronic pancreatitis, marked obe- 

 sity, fatty degeneration generalized and testicular 

 hypertrophy. The sella turcica was found to be nor- 

 mal. Hypophysis was normal in both macroscopic and 

 miscroscopic sections. The adrenals contained a great 

 deal of fat and showed beginning softening of the cen- 

 ter. 



