138 PHYSICAL EXPRESSION. 



Case 20. Congenital jaundice Double hydrocele, 



Case 21. Ichthyosis No other deformity. 



Case 22. Ichthyosis, moderate in degree No- 

 other defect. 



Case 23. Ichthyosis Deformity of both ears 

 Heart healthy. 



Of the twenty-three cases, thirteen were males and 

 ten females. Looking at these cases from the point 

 of view indicated, the following points seem worthy 

 of consideration : The coexistence of deformities- 

 was not uncommon. This is seen in all the cases 

 in Group I., also in Cases 14 and 20 ; while in 

 Nos. 12 and 18 the head was also below the 

 average size. The family history is noteworthy as 

 giving indications of possible causation. In Cases 

 2, 6, 10, and 14, a feeble constitution in the 

 family is indicated by miscarriages, many deaths, 

 insanity with epilepsy in previous members of the 

 .families before the birth of the patients described. 

 It also appears in some histories that the tendency 

 to ill-development exhausted itself, the later 

 members of the family appearing healthy. The 

 secondary effects of the congenital defect are im- 

 portant. Defect of heart may lead to cyanosis, 

 clubbed fingers, and perhaps low temperature; it 

 is also said to lead to a low mental development. If 

 the internal ears are faulty, dumbness may follow ; 

 obstruction of the common bile-duct must secon- 

 darily cause jaundice. Ichthyosis being attended 

 with inaction of the skin, secondary bronchitis is 

 common. Cleft-palate may lead to atrophy from 

 inanition, and a head below size may lead to 



