Page:The Indian Medical Gazette1904.pdf/42

 In the lower limbs, the condyles of the feraur, tibia, awd fibula, except its head and upper part, are affected, patella not involved, greatest thickening round and above malleoli, toes all enlarged at the terminal phalanx. In the fore- arm the thickening involves the lower third or so of both bones, best marked just above the wrist, fingers enlarged at the terminal phalanx like the toes, tarsal and metatarsal bones not affected.

The skin over the leg bones appears a little thickened. In the knee and ankle joints, the depressions by the side of the patella and the malleoli respectively are obliterated by solid oedemu,

Face. — Small, triangular, with the apex of the triangle at chin, asymmetrical, left side being more prominent, due to the prominence of the malar bone and the angle of the jaw. Nose deviates to the right and is very prominent, bridge oi nose sunken and low, nasal bones normal. Palpebral fissure apparently normal, forehead small, vertical, not at all prominent. Tongue protruded in the middle line, uvula pushed over to the right, teeth fairly regular and good. Horizontal rami of lower jaw apparently not thickened, but the left angle of the lower jaw and the left ascending ramus are much thicker than the right. The alveolus of the superior maxillary from the first bicuspid back to the last malar on both sides fairly thickened. Hard palate, markedly arched jBLud very high, no irregularity to be felt with the finger, left malar bone somewhat prominent, supra-orbital ridges not thickened and not prominent, zygomatic arch fiormal, occipital ridges are prominent.

Cheat, — Narrow, small, phthenoid in character, clavicles, prominent, supra-and infra-clavicular