MULTIPLE DUCTLESS GLANDULAR SCLEROSIS 445 



beard began to fall out, and the axillary and pubic hair and the hair on the trunk gradu- 

 ally disappeared. Since this time the patient has been an invalid. Later, the physicians 

 regarded the nephritis as cured; although the puffiness of the skin never left entirely. 

 The patient is very apathetic, tires very easily, shivers, is never quite warm, has never 

 attained his former body weight, mental work exerts him very much, he sleeps poorly 

 at night, suffers from pressure in the head, sometimes complains of drawing pains in 

 the back and legs; lately the swelling of the face has again become distinct. Also the 

 pallor of the face has increased. He has visited different bath resorts and taken many 

 medicines, among them iodine and arsenic. The bowel movements often occur at inter- 

 vals of four to five days. Recently, albumin has again been found in the urine. 



The patient came under my observation in May, 1911. Medium height, cachectic 

 appearance, looks very much older. Face pale with a light yellowish tinge. Distinct 

 puffiness of face, especially about the eyes, on the cheeks and lips. Light livid discolora- 

 tion of the middle of the cheeks. On the upper lips mustache hairs very scanty; chin 

 and cheeks bald. Hair of head thinned out, dry, and brittle, at certain places much more 

 scanty, especially on the occiput. The trunk is bald, there are no hairs in the axilla; at the 

 root of the penis a few scanty hairs only, the perineum is almost free from hair. Tongue 

 perhaps somewhat thickened. Teeth poor, partly carious, the crowns much worn away, 

 transverse folds on the forehead, skin in the supraclavicular fossse shows slight pad-like 

 thickening, elastic; also the skin on the backs of the hands and feet is more elastic, other- 

 wise skin on trunk is rather rich in fat. Several lens-shaped specks of pigment on the 

 mucous membrane of the cheeks. Many places, on the skin more strongly pigmented as 

 in the folds of the palm of the hand, also in the vicinity of the nipples, on the backs of the 

 hands, forearms, also about the waist. Breasts not enlarged. Mons Veneris rather rich 

 in fat; no especial deposition of fat on hips. Findings as to cranial nerves entirely normal, 

 except that Chvostek II distinctly positive. Trousseau negative. Pupils react promptly. 

 Eye-grounds normal. Patellar reflexes weak. Size of heart normal to percussion; faint, 

 weak, systolic murmur at Erb's point. Pulse 68, tension slight, blood-pressure (Riva 

 Rocci) 65, liver not enlarged, spleen not distinctly palpable, neighborhood of the kidneys 

 on each side not especially sensitive to pressure. Penis small, about 7 cm. long. Skin on 

 penis folded. Testicles on each side about the size of a bean, soft, epididymis also small, 

 somewhat hardened. Scrotum small, soft. Examination per rectum shows that the 

 prostate is very small. Examination of the blood: leucocytes 12,000 of which 51 per cent, 

 are neutrophiles and 5 per cent, eosinophiles. In the urine no sugar, traces of albumin. 

 Slight dulness over the right apex, very few rales. Vesicular murmur somewhat weakened. 

 Therapy. Thyroidin tablets o.i gm. t.i.d. After two and one-half months report 

 by letter that the myxedematous manifestations have improved, but the deteriora- 

 tion in strength has progressed. 



Symptomatology. The cases described show a very noteworthy agree- 

 ment with one another. It is therefore not difficult to delineate the clinical 

 picture of the condition. All cases show in pronounced manner the symp- 

 toms of late eunuchoidism, an exact description of which I need not enter into 

 here. This syndrome, however, constitutes only one, although one of the 

 most emphatic expressions in the total picture of the disease. To it is 

 added in all cases a most irresistibly progressive cachexia, and mostly also, 

 as far as investigations have determined, a pronounced anemia. Hence it 

 occurs that such patients in spite of the boyish beardlessness of face, do not, 

 as in late eunuchoidism appear younger than they really are, for the most 



