THE DISEASES OF THE HYPOPHYSIS 



June 3, the patient observed that his hat, that also had been too small, now fell down 

 on his forehead. On June 9, an improvement in the attention became apparent. The 

 patient, who was a doctor of mathematics, could, before the onset of his illness, repeat 

 all of 12 two-digit figures that were told to him at intervals of five seconds. Before the 

 operation he could remember only 7. Now he regularly repeated n. June n, the 

 greatest circumference of the head which before the operation reached 62.5 cm., is now 

 61.4 cm. The greatest circumference of the neck, formerly 46 cm., now is 43 cm. The 

 water displacement of the hands which formerly was 700 cc. is now 600 cc. The thicken- 

 ings about the eyes have now retrogressed, and the soft parts of the cheeks and chin have 

 also distinctly fallen off. On June 19, the patient left for his home. 



Histological examination of the material obtained on operation (D. Erdheim) showed 

 an adenoma consisting in small round cells that look alike, with round vesicular nuclei 

 and a well-developed protoplasm; at regular intervals the tissue is permeated with blood- 

 vessels with capillary walls, giving to the tumor a trabecular, in some places an alveolar, 

 appearance. At places proliferation and hyaline degeneration of the stroma, often with 

 extensive hemorrhage. I mention briefly, from the patient's report in July that the sweats 

 have improved considerably, from his report in August that the circumference of the head 

 has decreased still more, the thirst has subsided, but there has been no alteration in the 

 vita sexualis. In January, 1912, he reported that retrogression of the acromegalic mani- 

 festations had not gone further; that lately even an aggravation had set in, this consisting 

 in the fact that the tongue had become thicker, the mental attitude was that of depression, 

 the thirst had again become greater, but there was no more polyphagia. 



Often too the eyebrows became bushy. In women often hairs develop 

 on the upper lip, and bristly hairs on the chin and on the lower lip, similar to 

 the chin-beard in man, also hairs on the cheeks, and especially on the inner 

 side of the thigh and even on the linea alba (also a case of Stumme's} . This 

 occurrence of abnormal hairiness in women is illustrated by the following 

 case: 



Observation XXVII. E. T., thirty-three years, entered Nov., 1909. Menstruated 

 first at the age of twelve years, followed regularly at intervals of four weeks, the flow 

 lasting eight days, profuse. Lues at the age of nineteen years, primary sore on the left 

 labium minor, twelve injections, after six weeks papules in the genitals, nineteen inunc- 

 tions. The end of 1895, an abortion, and 1898 apparently a purulent parametritic exu r 

 date, 1907 another abortion. 



The present illness began in 1902 and within one-half year had attained almost its 

 present intensity. First paresthesias in the upper extremities and shoulders, then thick- 

 ening of the fingers, so that the patient had to discard her rings. A half year later en- 

 largement of the feet, so that the shoes became very much too small. At the same time 

 occurred enlargement of the lips and nose. The circumference of the neck had increased 

 about 4 cm., the abdomen also became thicker, and hair began to grow on the breast and 

 calves. The breasts did not become especially larger, but milk began to be secreted by them. 

 Periods extremely irregular, at one time remained away for seventeen months, libido 

 at first increased, then diminished. The voice right at the onset became deeper. Lately 

 frequent outbreaks of sweat. Occasional voracious hunger and great thirst. Often 

 frontal headache. 



Typical acromegalic appearance. Hands and feet enormously large. Skin very 

 moist, marked hairiness of both arms, hairs between the breasts and on the genitals, the hairs 

 of the mons veneris reach as high as the navel. Hairiness therefore that of a man. Cir- 



