THE PATHOGENESIS OF ACROMEGALY. 205 



its weight, however, as many other valuable hints have in 

 medicine, simply because it did not happen to fit every case, 

 and notwithstanding the fact that the organ had been found 

 persistent at autopsies and in some cases enlarged, by a num- 

 ber of pathologists. The form of acromegaly due to supra- 

 renal overactivity just discussed seems totally disconnected 

 from the thymus; but this does not mean that a persistent 

 thymus should not play the main role in the causation of a 

 second form: i.e.., one prevailing in adolescents or young adults. 



Percy Furnivall, 40 in an analysis of 17 cases of acromegaly, 

 found that the thymus was absent in 7, but hyperlrophied in 3, 

 and persistent in 7: i.e., nearly 60 per cent, of the cases. The 

 only constant associated changes appeared to be in the pituitary 

 body. At the same meeting of the Pathological Society, Rol- 

 leston 41 referred to the case of a woman, aged 35 years, who had 

 shown symptoms of acromegaly for three years. "She suffered 

 from optic atrophy due to the pressure of the tumor; head- 

 ache, which was intense at times; and transient glycosuria. 

 The skeletal changes were quite characteristic.". The patient 

 died "after an epileptiform fit." . . . "The pituitary tu- 

 mor was a round-celled sarcoma the size of a walnut." . . . 

 While the thyroid gland appeared normal, "the thymus gland 

 was persistent, and was much in the condition of that of a 

 child before the changes of involution had set in." We have here 

 not one phenomenon, but two distinct manifestations of. as 

 many individual functions: Suprarenal overactivity, as repre- 

 sented by the epileptiform fit; excessive activity of the pituitary, 

 as represented by the acromegalic symptoms. 



Why do we not have in the above case a third manifesta- 

 tion traceable to the presumably active thymus? We have 

 seen, when considering the physiological action of the thymus, 

 that this organ and the adrenals are interdependent as long 

 as the activity of the thymus lasts: i.e., until puberty. But 

 after puberty, and when the thymus becomes normally atro- 

 phied, are the adrenals deprived of this stimulus? To answer 

 this question negatively would be to concede that after puberty 

 the bodies that furnish phosphorus in organic combination, and 



* Percy Furnivall: Lancet, Nov. 6, 1897. 

 41 Rolleston: Lancet, Nov. 6, 1897. 



