HYPOPHYSIAL DYSTROPHY 285 



Observation XXXIII. J. L., ten and one-half years old. Entered the clinic June, 



1909. Has a poor heredity. Father and two sisters are insane. An eight-year-old 

 brother is hard of hearing. Three years ago began violent headaches, that gradually 

 increased, and recently there occur, now and then, slight attacks of vertigo. Some- 

 times the lad sees indistinctly and with blurring. Sometimes there occur parching sen- 

 sations of thirst, polydipsia and polyuria. Obesity has developed only recently. For two 

 years growth has been at a standstill. 



The boy is rather small for his age. 



Height, 131 cm. 



Circumference of skull, 56 cm. 



Jugulm-symphysis, 45^ cm. 



Chest circumference, 80 cm. 



Distance between the spines, 30 cm. 



Upper extremities, 62 cm. 



Upper arm, 24^ cm. 



Anterior superior spine to lower border of patella, 38 cm. 



From there to internal malleolus, 31 cm. 



The boy is very fat, especialy in the pelvic region, on the outer side of the thigh, and 

 on the mons Veneris. The penis is abnormally small, the testicles also small, the mammae 

 are very rich in fat, genua valga. 



The intelligence is normal, the status of the nervous system shows normal conditions, 

 with the exception of nystagmoid twitching in all end-positions. Fundus and perimetry 

 are normal, the development of the hand-skeleton about corresponds to the patient's age, 

 no alimentary glycosuria (100 gm. dextrose). 



The X-ray examination of the skull shows: 



Sella turcica not deepened, but the entrance to the sella is remarkably broad. This 

 makes the clivus somewhat more sharpened. 



Adrenalin o.ooi gm. subcutaneously, no glycosuria. 



Diagnosis: Dystrophia adiposo-genitalis, probably hypophysial. 



I cite the following as a typical case of hypophysial dystrophia adiposo- 

 genitalis. 



Observation XXXIV. 1 L. S. B. [female] from Russia. Sixteen years old. Entered 

 the clinic Nov. i, 1911. Family history shows nothing bearing on the case. Nine years 

 ago the patient sustained a febrile disorder which she states was typhoid fever. After the 

 recovery the body weight began gradually to increase. She eats a fair amount of food since 

 that time, but especially has she noticed an increase of thirst, so that she often has to get up 

 at night to drink. She also urinates very frequently. The patient believes herself to 

 have been well otherwise until about three years ago. At that time she began gradu- 

 ally to complain of severe headaches, especially at night. She complained of formications in 

 the hands, and remarked that there was a decrease in the power of vision. Already at that 

 time an eye doctor had forbidden her to read. Lately the headaches have gradually 

 become worse, especially at nights, the patient readily becomes fatigued, and four months 

 ago she remarked one day that she could not see at all with the left eye. At the end of May, 



1910, an eye doctor diagnosed bitemporal hemianopsia, optic nerve atrophy, vision O. D. 

 10/40, O. S. 10/70. At the end of August, 1911, there was a supplementary report, O. D. 

 10/50, O. S.: Counts fingers just in front of the eye. 



At present there are headaches almost daily; for six months there has existed falling 

 out of the hair, the nails have not become brittle; however, the patient is almost always 



. l The case has been also published in detail by O. Hirsch. 



