GIGANTISM 815 



Right Left 



Circumference of wrist 16.5 cm. 16 cm. 



" of thigh 59 " 58 " 



" of knee over patella 41 41 " 



of calf 40.5 " 40.5 " 



Length of foot 27.3 " 27.2 " 



Width of foot at base of toes 12 " 11.8 " 



Height of knees 55 cm. 



Width of shoulders across back 39 " 



On physical examination he appears like an overgrown child, simple 

 mannered, very frank and good-natured, and will do anything he is 

 told to do. His head is relatively small and face comparatively thin. The 

 forehead is low. There is abundant hair on the head, but none on the 

 face or other parts of the body than the axillae and pubes. No cranial 

 nerve disturbance is found. The nose, tongue, mouth, lips and lower 

 jaw are not at all enlarged. The tonsils are not enlarged. The palate 

 is not deformed. The thyroid gland is not enlarged; it can be felt. 

 The lower part of the neck is thick, the upper rather thin. There is a 

 prominence over the upper part of the sternum at the level of the third 

 rib. The trunk is decidedly feminine in appearance : the breasts are pendu- 

 lous, symmetrical, with nipples 6 mm. in diameter, surrounded by pig- 

 mented areolas, 25 mm. in diameter. No secretion can be expressed. 

 There is a large amount of subcutaneous fat. The hips are broad. The 

 pubic hair is 3 cm. long, its upper border being horizontal, 3 cm. above 

 the root of the penis. The abdomen is prominent and pendulous like 

 that of a woman who has borne children. The penis and scrotum are 

 small (see measurements). Two very small testicles can be felt. The 

 heart is of normal size on percussion; the apex impulse is very feeble. 

 There is no dullness in the region of the thymus. The patellar reflexes 

 are sluggish. Sensation is normal. The voice is high-pitched. The grip 

 is weak. The veins about the left ankle are prominent. There are 

 pigmented superficial scars over the left leg, anteriorly. He shows 

 marked pes planus. 



Congenital Syphilis and Gigantism 



In the literature certain cases of gigantism, especially those of Sirena, 

 Nobl, and Fuchs are attributed to congenital syphilis, and E. Fournier 

 also includes that-of Buhl (to be described later). It is probable that in 

 some of these cases the syphilis has affected the genital organs and pro- 

 duced a state of eunuchoidism to which the growth disturbance is due. 

 Thus, Werther describes and pictures a boy 16 years old, with extraor- 



