898 



WALTER TIMME 



are usually delayed in their appearance they also show certain characteris- 

 tic anomalies. The lateral incisors, especially in girls, are frequently 

 greatly underdeveloped. The canines, likewise, are either underdeveloped 

 or else take on the flat appearance of incisors, losing their fang-like appear- 

 ance. With the cyanosis of the extremities we occasionally get a pustular- 

 like eruption about the nails. The symptoms during the second stage may 

 need some elucidation. The so-called " white line" of adrenal insufficiency 

 was first described by Sergent. It has not been proved to be due to the 

 deficiency, but in nr) experience it invariably accompanies fatigue 



fc'ig. 0. Shows sella turcica of patient Fig. 

 fossa by massive clinoids. 



5. Complete e losing in of pituitary 



states, and may be made to disappear very quickly after a hypodermic 

 injection of epinephrm. Previous emotional disturbance, even so slight 

 as that produced by standing before a camera to be photographed, will 

 make its appearance impossible to obtain. It is obtained best by having 

 the patient lying quietly in bed for a short while and then stroking the 

 skin, preferably of the abdomen or thigh, lightly with the palmar surface 

 of the index finger. In ten to twenty seconds there will be a blanching of 

 the skin thus stimulated. (See Sergent's article, I'.HT, for the explanation 

 of this phenomenon.) The low carbon dioxid combining power of the 

 blood plasma diminishes the so-called "buffer"' property of the blood and 

 leads to acidosis on slight provocation. The/ smooth soft skin of these 

 patients, even in the third decade of life, with little or no secondary hair 

 on the face, a faint suspicion of lanugo on the lip and chin, and a "peaches 

 and cream" complexion, frequently stamp these cases at sight. The head- 



