HYPOPHYSIAL DYSTROPHY 



305 



Observation XLIV. Case F., fifteen years old. Entered the clinic September, 

 1912. The mother of the patient states that the birth was normal, but that she cannot 

 say with certainty when the growth disturbance first began; but that there was rachitis 

 at the eighth year. The child walked late. The abdomen at that time was distended. 

 At all events it is to be supposed that the growth disturbance goes back very far. When 

 the mother was asked concerning fat stools, she answered that these had existed as long as 

 she can remember. Measles at six years of age. In early childhood, patient had frequent 

 sweats. Of late years, he has become thin, and has felt very weak; he became silent 

 and melancholy. He complains of" violent vertigo and of 

 headache. For three weeks diarrheal evacuations, that have 

 seemed fatty. The development of the intelligence was ap- 

 parently normal. 



The boy measures 121 cm., the span width is 121 cm., 

 lower length (from ant. sup. spine to internal malleolus) 63 

 cm. The skull has the form of a tower; the greatest circum- 

 ference measures 61% cm. The tubera frontalia project to 

 a degree, no saddle-nose, the teeth are very bad, the incisor 

 teeth are much ridged, certain teeth belonging to the milk 

 set. Genua valga. The color of the face is pale, the skin of 

 the entire body is white, remarkably delicate, quite feminine. 

 The patient is thin, but nevertheless there are deposits of 

 fat on the hips and nates, in the hypogastric regions and 

 somewhat more distinctly on the mons Veneris. No rosary 

 formation; no bending of the extremities. No glands pal- 

 pable. Lung-findings normal. The heart sounds are clear, 

 after several sittings extrasystoles. Examination with the 

 electrocardiogram shows complete dissociation. 



The development of the genitalia has remained behind to a 

 marked degree. The penis is small, prepuce well developed. 

 The inguinal canals are pervious for two fingers, the testicles 

 lie in the inguinal canal and come down a little only on 

 marked coughing. They are about the size of beans and 

 very soft; the paradidymis is hardly delimitable. The hairi- 

 ness on the trunk and genitalia is entirely absent. 



Wassermann reaction negative. Alimentary glycosuria 

 (200 gm. dextrose) negative. 



Blood count: Erythrocytes, 4,800,000 



Hemoglobin, 45 per cent. 



Leucocytes, 5900 of which : 



Polymorphonuclear leucocytes, 64 per cent. 



Lymphocytes, 25 per cent. 



Large mononuclears, 4^ per cent. 



Eosinophiles, $% per cent. 



Mast-cells, i per cent. 



The eye examination shows prominent eye-balls, oblique palpebral fissures, dilated pupils, 

 icrves pale, well delimited; the vessels, especially the veins and the peripheral and muscular 

 tranches are appreciably convoluted without dilation, old neuritis (?) (Docent Ulbrich). 

 X-ray. Skull strikingly large and high; hydrocephalus, sella of normal dimensions, 

 dilated only at its entrance, its contour retained. The dilatation of the entrance to the 

 sella is perhaps only a partial manifestation of the hydrocephalic extension of the skull 

 (Docent S chillier). 



FIG. 59. 



