DYSTROPHIA ADIPOSOGENITALIS 887 



disposition, ffis strength was good, and he was accustomed TO manual 

 labor, hauling lumber with ox-team. There were no symptoms referable 

 to his gastro-intestinal, cardiovascular, respiratory or genito-urinary sys- 

 tems, and no neuromuscular symptoms except ptosis of (left) eyelid jmd 

 strabismus. 



Physical Examination. Patient looked bright and answered simple 

 questions promptly and intelligently. His appearance was that of a boy 

 of thirteen, or four years his junior both in regard to height and general 

 development. The general outline of the body was distinctly feminine 

 with delicate features, especially the texture of the skin and the size and 

 shape of the extremities. His breasts were well developed. The lower 

 abdomen was quite prominent and the hips and upper thighs were rela- 

 tively large. The skin was peculiarly dry, light in color, and delicate 

 for a boy much exposed to the sun. There was complete absence of body- 



Fig. 16. Left Pituitary hands "Type en petite" of the boy (aged seventeen) 

 seen in Figure 15. Note the gracile form, the smooth delicate skin and the tapering 

 fingers as compared to those of a normally developed boy nine months younger. 



hair. The face was beardless; on the upper lip there were a few fine 

 lanugo hairs and the axillary and pubic hair were absent. 



There was a slight prominence over the occipital bone, otherwise the 

 outline and contour of the skull was normal. Directly in front of the 

 right ear was a small congenital nipple-like projection, the size of a pea. 

 The facies suggested adenoids. The upper teeth projected beyond the 

 lower, producing well marked maxillary prognathism. The left eyelid 

 was ptosed. The left pupil was larger than the right but responded well 

 to light and accommodation. External strabismus was present in the 

 left eye. Mucous membranes were pale. The upper teeth were irregular ; 

 the lower were small, separated, and showed evidence of pyorrhea. No 

 history could be obtained in regard to the time of dentition. The super- 



