THE PATHOGENESIS OP ACROMEGALY. 193 



per se, but a condition capable of readily associating itself 

 with other disturbances of nutrition, especially acromegaly. 

 This may be true, since gigantism may not be followed with 

 acromegaly, while the statistics of W. Hutchinson 17 show that 

 40 to 60 per cent, of these prodigies are also acromegalic. 

 This statistical proportion suggests, therefore, that 40 to 60 

 per cent, of giants are not cases of acromegaly. 



Yet this does not bear very deep examination. Typical 

 giants are really weaklings; while abnormal strength may pre- 

 vail, this does not last, and they reach an early grave. Indeed, 

 Hutchinson found that the ultimate result was similar in both ; 

 the location of the outgrowths and the sexual disturbances are 

 similar, and about the only difference between them that he 

 could detect were the symptoms due to the intracranial press- 

 ure of the growth and the more rapid course of true acromeg- 

 aly as compared to gigantism. The position that seems best 

 to harmonize with the data available is that of Marie, 18 who 

 first described the disease and gave it its name: acromegalic. 

 His view has always been that gigantism occurs in the adoles- 

 cent when the acromegalic tendency is present during the 

 period of growth, whereas if it appears after full development 

 i.e., in the adult the hypertrophic process occurs mainly at 

 the extremities of the long bones, due to intense peripheral 

 histogenesis. Further studies have extended these restricted 

 limitations, however, and it is now known that there is not 

 only hypertrophy of the extremities, but also of the bone 

 proper, the voluntary muscles, the cellulo-adipose tissues, the 

 skin, the lymphatics and often of the viscera, the liver, spleen, 

 the kidneys, etc., a true histogenesis of practically all tissues. 



A logical inference to be drawn from this abnormal de- 

 velopment is that the underlying causative factor must be a 

 morbid overproduction of building elements. In other words, 

 if the pituitary serves to provide the organism with a building 

 product manufactured by it from elements obtained through 

 food, etc., a view in conflict with many prevailing doctrines, 

 even that of Marie, who believes that the pituitary through 

 disease becomes incompetent to neutralize various substances 



17 W. Hutchinson: New York Medical Journal, July 21 and 28, 1900. 



18 Marie: Bulletin de la Soci6t6 des Hopitaux de Paris, vol. xii, 1896. 



