F—, single, æt. 61, admitted in December, 1912, and died in April, 1913. History very defective. Mental symptoms had been present for some years. She was very thin and haggard, with marked exophthalmos. The hair was so scanty that she was nearly bald. A fairly large firm and elastic goitre present. One insane ear. Reflexes exaggerated generally, but equal. Muscular system normal. Complete absence of subcutaneous fat. The skin over the front of the abdomen and, to a less extent, that of the rest of the trunk and of the upper parts of all four limbs, was covered with raised, discrete, warty-looking masses. The skin could be picked up from the underlying tissues except in one place on the back of the left thigh, where the skin was atrophied, pigmented, shiny and adherent to the deep tissues, and had been subjected to a good deal of scratching. The skin of the face and hands was quite normal. She was very restless and difficult to examine. She suffered from chronic bronchitis, and had a mild tachycardia as well as a mitral systolic bruit. She suffered from very vivid hallucinations of sight and hearing, and was very excited in consequence at times. She became gradually thinner during her stay here, and passed into a marasmic condition in which she died.
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