Figures 7c-7e: The same patient as in Figure 7a and 7b aged 29. Reexamination in 24 years after the first examination. Inability to pucker lips to whistle; severe atrophy of the sternocostal portions of pectoralis major muscles on both sides (c), severe involvement of the middle and lower parts of trapezius muscles (d), inability to stand up on the heels (e).