342 ON GROWTH AND OVERGROWTH 



ary organs of generation, as also of the muscular system. But 

 this associated growth must be regarded as secondary and 

 co-ordinate. In each of these cases we are struck by the fact 

 that one particular tissue shows excessive growth, whereas other 

 associated tissues, while presenting increased growth, have that 

 growth proportioned rather than over-proportioned to the 

 excessive development of the particular tissue. 



3. While recognizing thus that excess or defect of particular 

 internal secretions exercises this specific action on particular 

 tissues, it is noteworthy that the particular tissues do not present 

 a universal hyperplasia or hypoplasia throughout all areas of 

 their distribution. In acromegaly, for example, it is the bones of 

 the face, hands, and feet that are more particularly involved ; 

 in pituitary giantism the bones of the limbs show excessive growth 

 rather than those of the trunk. Let it be admitted that mechani- 

 cal and other possibly deeper reasons exist for this regional 

 overgrowth of one or other tissue. Let us even admit that, as 

 has been suggested, in acromegaly it is a plethoric blood supply, 

 or an activity of the blood-forming organs, in short a primary 

 haemic change that induces bony overgrowth ; it still remains 

 that under the influence of altered internal secretions the growth 

 of one or other tissue is seen to lack proportion as regards the 

 relative regional development of that tissue, just as it lacks pro- 

 portion as between that tissue and the other tissues of the body. 



From this group of cases we pass to another so similar in basal 

 properties that we must, I think, conclude that it is of the same 

 type, the group, namely, to which it has been customary to limit 

 the name " Riesenwuchs." Of this the most typical example 

 is adiposis and the allied conditions. Even where adiposis is 

 generalized every pathologist is forced to recognize that there 

 is an individual variation in the laying down of the fatty tissue. 

 Some cases, for instance, presenting a large panniculus adiposus 

 exhibit but a meagre deposit of fat in the mesenteries and omen- 

 tum ; and vice versa. We encounter, however, striking examples 

 of local overgrowth of the fatty tissue. I need but recall the 

 symmetrical lipomatosis seen more often in males, involving it 

 may be especially the neck, the submaxillary, or parotid region, 

 but in other cases seen in the mammary region, the perineum 

 and scrotum, or the inguinal region. With these must be noted 

 the characteristic distribution of the fatty overgrowths in 



