884 



HAKVEY G. BECK 



She had an insatiable thirst, getting up four or five times every night, 

 voiding enormous quantities of clear, limpid urine and drinking three 

 glasses of Water each time before returning to bed. 



She also complained of dyspnea on exertion, excessive fatigue, neuro- 

 muscular pains, drowsiness, mental irritability, emotional disturbances, 

 and headaches. Despite the fact that she rapidly gained in weight her 

 appetite was poor and her bowels were constipated. Gastric analysis 

 showed free IIC1 46 and total acidity Y6. The blood showed a moderate 

 grade of anemia and a positive Wassermann reaction. She eliminated 

 from 8000 to 13000 c.c. of urine in twenty-four hours. The specific grav- 

 ity ranged from 1.002 to 1.004 and was negative both chemically and 



microscopically. The 

 pulse was slow and 

 blood pressure subnor- 

 mal, systolic 104^ dias- 

 tolic 84. There was a 

 soft, blowing systolic 

 murmur at the apex. 

 Slight pitting occurred 

 on pressure over the 

 shins. Temperature 

 was subnormal. The 

 thyroid, which con- 

 tained a small, firm, 

 nodular mass, was 

 slightly prominent. 

 Tendon reflexes were 

 sluggish. There were 

 no visual field disturb- 

 ances and the eye- 

 grounds were normal. 



X-ray findings. The interpretation of a lateral plate showed bones of 

 the cranial vault unusually thick, especially those of the posterior por- 

 tion. The sol la was small and flattened and the anterior clinoid processes 

 much thickened and elongated. (Fig. 13.) 



There was no amelioration of symptoms on antiluetic treatment. On 

 thyroid and pituitary gland substance the fat was temporarily redis- 

 tributed and the diabetes insipidus was partly controlled by pituitrin. 

 (Fig. 14.) 



The case was lost sight of for two years when she was again seen 

 in consultation with Dr. Hocking the day before she died. With the 

 exception of two months, she was regularly employed until six weeks 

 before death, when she was compelled to discontinue her work on account 

 of lethargy, stupor, and dullness. For several months previous she had 



Fig. 13. Abnormally small closed-in sella: En- 

 largement of the anterior clinoid processes and thick- 

 ening of the cranial bones. 



GROUP A, CASE XV. Dystrophia adiposogenitalis; 

 amenorrhea, diabetes insipidus, positive Wassermann, 

 narcoleptic attacks, hypotension. ( Rontgenogram by 

 Dr. A. Cotton.) 



