344 INTERNAL SECRETION 



the infantile ; but they lay stress upon the fact that the number of 

 cases included in the former class increases as the two forms are 

 more carefully studied, and that it would be hardly possible to 

 bring forward a case of infantile gigantism which did not present 

 some of the signs of acromegaly. The subject of infantile gigan- 

 tism, if he lives until his epiphyses are ossified, becomes acrome- 

 galic. After that, he ceases to increase in height and the 

 endochondral is replaced by periosteal hyperossification. Launois 

 and Roy showed that the skeleton of the giant Constantin, whose 

 skeleton they very minutely investigated, presented the infantile 

 type of gigantism in the extremities and the acromegalic type in 

 the skull. Gigantism is the acromegaly of those individuals, 

 irrespective of age, whose epiphysal cartilage has not undergone 

 ossification. If all the subjects of gigantism are not acromegalic, 

 they may at least become so. The fact that disturbances of 

 growth are invariably associated with pathological changes in the 

 hypophysis, led these authors to regard that organ as the source 

 of origin of gigantism. 



That the hypophysis plays a leading part in the pathogenesis 

 of gigantism is undoubted. This applies to those cases particu- 

 larly in which gigantism has, from the first, been associated with 

 acromegaly. In infantile gigantism, on the other hand, primary 

 disgenitalism must be included as a probable causative factor. 

 This is suggested by the similarity of the symptoms in this con- 

 dition with those observed after castration before the onset of 

 puberty, as well as by the relatively slight changes in the hypo- 

 physis and the lateness of the stage at which these take place. 

 According to Fichera, these changes are also only secondary 

 results of the suppression of the activity of the sexual glands. The 

 peculiar disposition of the hypophysis to pathological change, to 

 which reference has already been made, may be the reason why, 

 in these cases, the processes of growth are more prolonged, and 

 the dimensions of the individual thus greater than is commonly 

 the case after castration. 



A further factor in favour of gigantism is supplied by the 

 thyroid gland. After early castration the thyroid generaliy 

 atrophies and the suppression of its function brings about an 

 inhibition of the processes of growth. But in the majority of the 

 subjects of gigantism the thyroid has been found to be normal or 

 even hypertrophied ; it seems possible that the condition may, in 

 part, arise from the fact that the abnormal stimulation of the 

 processes of growth, which results from the suppression of the 

 sexual glands and the hypertrophy of the hypophysis, receives no 

 inhibitory check from the thyroid gland. 



A few attempts have been made to treat gigantism by organo- 

 therapeutic methods with ovarian and testicular extracts, but 

 success has been very rare (Maisonave, Dor, Hudovernig). The 

 results seem to show, however, that the primary genetic factor in 



