Among the conditions that have been recognised as an expression of degeneracy is gout, which, as Fothergill long ago pointed out, is a reversion to the condition found in the sauropsidian liver and kidneys. Cullen had previously expressed the opinion that gout is a neurosis. Later researches tend to show that this neurosis is one controlling nutritive tissue change. The condition may occur early in childhood as well as at the periods of stress. The same is true of conditions like arthritis deformans, all of which may be the sole expression of degeneracy in an individual who exhibits many marked stigmata. Another expression of nutritive degeneracy is the senile atrophy of the skin described by Souques.[244] In a case of this kind under my care the patient, a twenty-six-year-old man, was born with club-foot. He has some musical talent. He is a marked degenerate. The skin is thick, coarse, and dry, giving him a very old appearance on account of its shrivelled condition. The ears are undeveloped, eyes small and sunken; excessive development of the cheek-bones; hair coarse and stiff; face arrested in development, possessing a partial V-shaped arch. The width outside first molar is 2; outside second bicuspid, 1·75; width of vault, 1·50; height of vault, ·58. One of the prominent features of degeneracy noticed in this case was the lack of hair upon the face. Disorder of the thyroid produces both dwarfing cretinism, and a myxoedematous condition of the subcutaneous tissues, increasing the quantity of the jelly-like material in these, and therefore approximating some conditions found in the invertebrates. Ichthyosis (the skin disorder producing the "fish men" of shows) is frequently an expression of degeneracy, often associated with deficient limbs and monsters in the same family. [Illustration: FIG. 107.] A condition due to heredity (involving an arterial change called arterio-capillary fibrosis) underlies many disorders like cirrhosis of the liver, kidneys, and other organs. It is usually an expression of premature senescence. Certain families for this reason exhibit a tendency to an early appearance of old age (Fig. 107), a tendency which, as Osler remarks, cannot be explained in any other way than that in the make-up of the machine bad material was used for tubing.