THE PATHOGENESIS OP ACROMEGALY. 199 



pituitary, suggests that the mental disease could not be at- 

 tributed with justice to pressure of the growth. This is fur- 

 ther sustained by the fact that visual disturbances, so fre- 

 quently noted, are not referred to, the eyes being "deeply 

 set and small." The case was, mentally, one of "mild, gradually- 

 increasing dementia." The second case is an instance of 

 feeble-mindedness with marked amnesia, with no tendency to 

 irritability, as in the former. With this feeble-mindedness, 

 however, is associated another disorder (one probably due, 

 as we have seen, to the sudden production and accumulation of 

 waste-products, and referable, therefore, to the adrenals, or, 

 rather, to exacerbative suprarenal overactivity) : i.e., epilepsy. 

 That mental shocks of various kinds often initiate exophthal- 

 mic goiter is well known. The patient had never been very 

 bright. At the age of seventeen he had been frightened, and 

 this marked the first of his fits, which have continued ever 

 since: i.e., twenty-seven years. As the acromegaly began 

 about seventeen years after the onset of the epileptic seizures, 

 it appears possible that this long-continued overnutrition of 

 the pituitary may have been the cause of his acromegaly 

 typical not only in respect to its specific symptoms, but also 

 to those distinctly traceable to the adrenals. Three years 

 before the report the more acute symptoms began to appear, 

 and when Dr. Hutchings's paper was published he had had 

 fewer epileptic seizures than formerly, but amnesia was more 

 marked: both signs that the cachectic stage i.e., that of 

 suprarenal insufficiency was approaching. In a very similar 

 case, in which weak-mindedness also prevailed, though no 

 epilepsy is referred to, Roxburgh and Collis 27 found at the 

 necropsy softening of an enlarged pituitary gland. 



Valuable in this connection is one of two cases of acro- 

 megaly with imbecility in adolescents reported by W. G. Shall- 

 cross 28 after a daily observation during a period of nearly six 

 years. In this case, now aged 18 years, rated as a "high- 

 grade imbecile" when admitted into the Pennsylvania Train- 

 ing-school, a marked change, both mental and physical, ap- 

 peared at the age of fourteen years, and a year later the signs 



27 Roxburgh and Collis: British Medical Journal, July 11, 1896. 



28 W. G. Shallcross: Philadelphia Medical Journal, April 20, 1901. 



