THE PATHOGENESIS OF ACROMEQALY. 197 



tion. All these symptoms except the latter are witnessed in 

 exophthalmic goiter, though muscles do not show, at first, the 

 general emaciation which is observed in this disease. Yet there 

 is every reason to believe that the activity imparted to the 

 adrenals by the secretion of the pituitary is less marked than 

 that caused by the thyroid secretion. Hinsdale, in his essay, 

 based on a study of one hundred and thirty cases of acro- 

 megaly reported in literature, refers to the muscular symptoms 

 as follows: "The muscular system varies in development with 

 the type and stage of the disease. Naturally, the strength is 

 great in the early period and particularly in the giant form. 

 . . . The facts that the disease has existed for a consider- 

 able time when the cases are reported and that they apply 

 to physicians for relief of symptoms explain why muscular 

 power is commonly noted as weak, as a rule. ... As 

 the period of decadence sets in, muscular atrophy renders 

 the patient quite powerless, and cardiac dilation adds to the 

 weakness of the circulation. Tremor 24 is not unusual in acro- 

 megaly." 



The cachectic stage as typically indicates the part played 

 by the adrenals in the morbid process. Besides the muscular 

 weakness just referred to, there is often marked sensitiveness 

 to cold. The reduced vascular pressure is shown by increased 

 rapidity and weakness of the pulse; and examination reveals a 

 dilated heart. Brooks, referring to the lesions of the vascular 

 system, says: "In short, the vascular lesions are found in their 

 most exquisite type in those portions of the body where the 

 circulation is slowest and where capillaries are most numer- 

 ous." Exoplifhalmos is also witnessed in many cases, including 

 the slow lid-motions, all probably due to the muscular debility; 

 sweating in common, and is doubtless ascribable to the weak- 

 ness of the muscular elements of the sweat-glands. Glycosuria 

 is commonly observed. Eeferring to the lesions of the skin, 

 Brooks also states: "Macroscopically, the skin in these areas 

 is considerably thickened; the surface is rough and often 

 fissured. A general brownish pigmentation is present in the 

 average case, which, at times, strongly resembles that found 

 in Addison's disease." 



2 * The italics are our own. 



