THE SYMPATHETIC SYSTEM 



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sausage shaped, square at the end and as large at the tips 

 as at the base. The nails are flattened more than enlarged, 

 short and hardly cover the dorsal surface of the last 

 phalange and are striated longitudinally. 



The lower extremities show similar deformities. While 

 the thigh and the leg keep their normal size, the ankle and 

 the foot are thickened. The feet in particular, are in- 



FIG. 9. Normal hand. (Infroid collection). Acromegalia hand. (Infroid collection). 



creased in volume, enlarged and thickened from the heel 

 to the toes. 



The malformation of the thorax is less constant. Some- 

 times these patients show a cervico dorsal kyphosis, so 

 that the head seems to have sunk in the shoulders. The 

 thorax decreases in length, enlarges from front backwards 

 and is separated from the abdomen by a deep groove; 

 protruding forwards and backwards so that there is no 

 question that the original "Punch" must have had acro- 

 megalia. This typical aspect of the thorax is due partly 

 to an alteration of the vertebra, by reason of abnormal 



