CASE OF HYPEROSTOSIS CRANII. 
By GUY HINSDALE, M.D.. 
Of Philadelphia. 
THIS specimen was recently presented to the Mutter 
Museum of the College of Physicians by Dr. 
Charles Herwirsch of Philadelphia, who has 
kindly furnished me his report of the case of which the 
following is a summary : The patient, a white woman, 
single, enjoyed good health up to her 64th year. She 
was a normal individual, mentally and physically, of a 
very lively disposition, and a hard worker. She was 
then attacked with rheumatism and confined to bed for 
one year, when the gradual enlargement of the head be- 
gan. Until within a few months ago she was able to go 
about her room with the aid of a cane, but in January, 
1896, she was unable to walk unattended, and had to 
be helped in and out of bed. Sne became listless and 
never conversed, but made short replies when spoken to. 
She never complained of pain, but did not like to have 
her head palpated. Near the time of her death, which 
occurred on March 13, 1896, she became very restless and 
troublesome at night, made frequent cries, and became 
impatient, and easily lost her temper. Insomnia, refu- 
sal of food, coma, and finally death at the age of 71. The 
head measured 71 cm. in fronto-occipital circumference, 
and between the meatus auditorii over the vertex 43 cm. 
The veins were very prominent over the scalp and pul- 
sation indistinct throughout the course of the tortuous 
and dilated temporal arteries. The lower half of the 
head was not enlarged. There was no acromegaly or 804 
AMERICAN NEUROLOGICAL ASSOCIATION. 
myxoedema ; but there was slight bowing of the long 
bones of the lower extremities, most marked in the left 
leg. 
On removing the calvarium the bone was found un- 
usually soft and friable, and could easily be pricked out 
with the scalpel. In the temporal regions the external 
and internal plates were fused ; elsewhere the relative 
amount of diploe was much diminished in proportion to 
the greatly increased size of the bone; this was most 
evident in the occipital region. The measurements at 
the section are as follows in millimeters. 
Fronto-occipital diameter, 22.8 ; biparietal, 18.8; sur- 
face length, sagittal, 31.2 Thickness, right occipital, 35; 
frontal, 29; left temporal, 14, TWENTY-SECOND ANNUAL MEETING. 
805 
The detached skull cap weighed 1870 gms. (4 lbs. 
2 oz.) The brain weighed 1360 gms. (48 oz.) 
There was nothing in the brain membranes note- 
worthy except a slightly indurated and thickened dura. 
The brain fitted easily in the normal sized cavity of the 
vault. The ventricles were hyper distended with clear 
serum; the ependyma was normal; no hemorrhagic 
lesion or other alteration was found in the encephalon. 
Both femors were thickened and slightly curved, with 
the convexities forward and outward. The epiphyses 
were much enlarged and covered with a new growth, 
capped as it were with osteoplastic incrustation or exos- 
tosis of friable mealy bone, more so than was exhibited in 
the skull-cap, where the densest bone of the body was 
found. 806 
AMERICAN NEUROLOGICAL ASSOCIATION. 
The specimen presents, therefore, the condition of 
rarefying osteitis or hyperostosis cranii. Baumgarten 
describes cases of this kind under the name of Leon- 
teasis ossea. Only two specimens in this country re- 
semble this one in size. One is in the Warren Museum 
at Harvard University, and measures inches in its 
greatest thickness ; the second is in the Army Medical 
Museum at Washington, and is from a mulatto woman. 
I am indebted to Dr. Curier R. Marshall for the photo- 
graphs and plates herewith presented.