THE PATHOGENESIS OF ACROMEGALY. 203 



thalmic goiter, then appears along with the pituitero-supra- 

 renal symptom-complex, acromegaly, in the same case. Wit- 

 ness the case reported by G. R. Murray. 33 The patient pre- 

 sented the characteristic signs of acromegaly, enlargement 

 of the bones and tissues, and those of exophthalmic goiter, 

 the enlarged thyroid, early exophthalmos, rapid heart-action, 

 etc. Hinsdale 34 refers to five such cases found in literature. 

 Again, the influence of overactivity of the three sets of 

 organs in bringing on the first stage of acromegaly is well 

 illustrated in a case described by Pearce Bailey. 35 Though the 

 patient was a woman 65 years old, the first signs of acro- 

 megaly had only occurred five years before her death (due to 

 an intercurrent pulmonary disorder) and were still plainly 

 those of the first stage. At the autopsy the thyroid was found 

 to be nearly three times its normal size; and "microscopical 

 examination showed that the gland-substance was generally 

 normal, although in places the acini were much dilated and 

 filled with colloid material." The pituitary was more than 

 eight times its normal weight. The posterior, or neural, lobe 

 presented no structural alteration; while the anterior, or 

 glandular, lobe was very vascular, the capillaries being dilated 

 and filled with blood. The history of the case, only obtained 

 after death, is very brief, and signs of suprarenal overactivity 

 suggesting exophthalmic goiter are not mentioned. But the 

 causes of death, "uraemia and pulmonary congestion," are, as 

 we will see, direct expressions of the capillary centrifugal 

 pressure that intense activity of the adrenals can produce, the 

 existence of which is shown in the pituitary itself by dilation 

 of its vascular net-work. Bailey also refers to a case of Van 

 Home Nome's, in which phenomena recalling the earlier 

 symptoms of acromegaly were found after death, associated 

 with a pituitary "enlarged to three or four times its natural 

 size, in which an extensive hcemorrhage had recently taken 

 place." During life another sign of peripheral capillary en- 

 gorgement, wide-spread parassthesia, had been present, evidence 



33 G. R. Murray: Edinburgh Medical Journal, Feb., 1897. 



34 Hinsdale: Loc. cit. 



85 Pearce Bailey: Philadelphia Medical Journal, April 30, 1898. 



