238 THE INTERNAL SECRETIONS—1920 
uitarism are based mainly upon the hypofunction of the 
posterior part of the pituitary. 
The main symptoms of acromegaly, outside of the 
excessive skeletal growth, are the enlargement of the 
nose, lips, ears, tongue, lower jaw, hands and feet. The 
skin appears to be coarse, rough, and thick, and often 
has a yellowish pigmentation. The patient acquires an 
enormous appetite—bulimia—and often suffers with 
very severe headaches (the organic “pituitary” or 
neighborhood pressure headaches). 
In hypopituitarism, increasing obesity is the predom- 
inant symptom; dwarfism and infantilism, when the 
individual is attacked in childhood. Feminism—the 
tendency in males to acquire feminine characteristics 
as to the distribution of fat and hair, and also as to the 
change of the voice—is quite frequent; amenorrhea is 
the rule in women, and the sexual activities are lowered. 
Lowered temperature, low arterial tension and con- 
tinuous drowsiness are also frequent. 
The physiological hibernation of animals and the 
normal sleep of man may have an etiological connec- 
tion in the temporary, suppressed activity of the pitui- 
tary. Adolescence and puberty are very likely con- 
trolled by hypophyseal hyperplasia. So may preg- 
nancy, with its temporary enlargement of the lips and 
nose, with thickening of the tissues of the hands and 
feet, be regarded as an “actual transient acromegalic”’ 
condition (19). 
THE GONADS OR ESSENTIAL SEX GLANDS 
Now, just a few words about the influence of the tes- 
ticles and ovaries and their respective hormones. The 
removal of the testes, or castration, produces a char- 
acteristic symptom-complex, seen in the eunuchs, the 
symptoms of which are described by Sajous (13) as fol- 
lows: “A tendency to obesity of a feminine type, due to 
slowed catabolism of fats, scantiness of hair, deficient 
