238 



THE DISEASES OF THE HYPOPHYSIS 



done only with the lateral teeth, as also the jaw was pushed forward. The pains and pares- 

 thesias were always worse in summer than in winter. For five and one-half years gradual 

 loss of libido, and later loss of erectibility of the penis. Entirely impotent for five years. 

 The acromegalic alterations greatly increased in intensity. The patient denied headache 

 and disturbances of vision. Lately there have reappeared drawing pains, especially in the 

 knees and ready fatigability; in addition to these, severe sweats. Alcoholism; patient 

 denies lues. 



Status. 168 cm. tall, coarsening of the facial features, cushioning of the lips, circum- 

 ference of the skull 58 cm. Marked protrusion of the orbital borders and the frontal pro- 

 tuberances. Circumference of the skull from the point of the chin to the top of the occiput 

 74 cm. Nose coarse, large, lower jaw markedly protruding, lower row of teeth is 1.5 

 cm. anterior to the upper row. The lower incisor teeth gape 3 mm. Tongue markedly 



FIG. 33. FIG. 34- 



Case of acromegaly (Observation XXIV). 



thickened and broadened and on account of the thick tongue, articulation is poor. Uvula 

 broad, tonsils enlarged, neck broad and compressed 34^ cm - m circumference. Submaxil- 

 lary glands palpable. Thyroid enlarged, left lobe more enlarged than right. 



The skin and visible mucous membranes somewhat pale. The skin rather thick but 

 may be readily raised from the underlying tissues in great thick folds. The hair of the 

 head rather abundant, the hairiness of the genitalia rather marked and also the thigh and 

 legs are rather pronouncedly covered with hair. 



Distinct kyphosis of the upper dorsal part of the vertebral column, slight lumbar 



