GENERAL DISEASES. 367 



there may be a general involvement of the skeleton. This excessive 

 growth is in the diameter rather than in the length of the bones, and is 

 accompanied by local exostosesv Equally important and common is a 

 general hyperplasia of the connective tissue of the body. Various lesions 

 of the thyroid have been described, but they are not constant. The thy- 

 nius may be persistent ; there may be fibrous-tissue formation in the walls 

 of the vessels and in the sympathetic ganglia. The skin is often pig- 

 meuted. Many visceral lesions have been described. The most con- 

 stant lesion which appears to bear upon the etiology of acromegalia is 

 that of the pituitary. This in many cases has been found to be the seat 

 of lesions, most frequently an hyperplasia or adenomatous growth in the 

 prehypophysis. While sarcoma of the pituitary has been described in 

 acromegaly, it seems not unlikely that hyperplasia has, in most cases at 

 least, been mistaken for this tumor. It is believed that the hyperplastic 

 hypophysis is in some way concerned in inducing the nutritional abnor- 

 malities 1 leading to the general overgrowth of connective tissue and 

 bone. 2 



PURPURA. (Purpura Haemorrhagica.) 



This name is applied to a variety of conditions in which extravasa- 

 tions of blood are present in Ihe skin or the mucous and serous mem- 

 branes. 



Haemorrhages, particularly from the mucous membranes, jnay__be^ 

 severe and even fatal. This condition is often called purpura hsemor- 

 rhagica. 



The ecchymoses characteristic of purpura may occur as a result of 

 poisoning with certain drugs, and with snake venom ; in various cachectic 

 conditions ; in diseases of the nervous system ; in rheumatism ; in gastro- 

 intestinal disorders, especially of children. The local ecchymoses in 

 pyaemia are sometimes classed as a form of purpura, and in these bac- 

 teria, especially the pyogeuic forms, may be demonstrable. 3 



LYMPHATIC CONSTITUTION. (Constitutio Lymphatica ; Status 

 Lymphaticus.) 



Attention has been recently called to a series of cases, especially in 

 the young and in connection with sudden death, in which there was gen- 

 eral hyperplasia of the lymph-nodes, spleen, and thy mus, with liypo- 

 plasia of the heart and aorta, and often with rickets. 



and feet and lower ends of the long bones, without involvement of the bones of the 

 face. While this condition may follow syphilitic infection, its frequent association with 

 pulmonary lesions has led to the designation liypertrophic pulmomiTy arthropathy. See 

 study and bibl. by Th. Janeway, Am. Jour. Med. Sci., vol. cxxvi., 1903, p. 563. 



1 Successful extirpation of 'the hypophysis in animals by Friedemann and Maas, re- 

 cently made, did not lead to acromegaly. See Berliner klin. Wochenschr., December 

 24th, 1900. 



' 2 For an excellent resume of acromegalia, with cases and bibliography, see Brooks, 

 "Archives of Neurology and Psychopathology, vol. i., p. 485, 1898. 



''For a more detailed consideration in the light of recent studies of cases often 



grouped under the name " Hsemorrhagic Infections," consult Honl, Lubarsch and Oster- 

 tag's "Ergebnisse der allg. Aetiologie," Jahrg. i., A 



Ab. 1, p. 793, bibliography. 



