256 THE DISEASES OF THE HYPOPHYSIS 



duced. Such a retrogression of a preceding goiter occurs frequently in the 

 later stages of acromegaly. With its disappearance may be associated not 

 only a disappearance of the Basedow's symptoms, but also, as in this case, the 

 appearance of symptoms of true myxedema. 



Observation XXXI. A. Str. First entered the clinic in February, 1896, then thirty- 

 one years old. 



Chlorosis at the age of eighteen years. Menstruated first at the age of fifteen years; 

 menstruation was regular until her marriage in her twenty-first year. Pregnancy and 

 delivery normal, child well. Since that time has never menstruated, and has become pro- 

 gressively weaker. Two years after the confinement (1898) the hands and feet began to 

 become thicker and coarser, the wedding ring had to be filed off and enlarged, and it had 

 to be made even larger in 1890 and 1893 respectively. Also the shoes had to be made 

 larger. The rest of her body became always thicker and more awkward, the neck 

 became swollen, but the breasts became progressively smaller. The facial features altered 

 more and more so that at times she was not recognized as herself by good friends. In spite 



FIG. 450. Before the disease. FIG. 456. At the height of the disease. 



Case of acromegaly. 



of the increase in body she became progressively weaker. Burning pains in the fingers oc- 

 curred early in the course of the disease, pains that were increased at night by the warmth 

 of her bed. Later were added day-sweats and night-sweats, so that night-clothing and bed- 

 linen had to be changed several times during the night. The eyes protruded distinctly. 

 Occasionally she had headache and vertigo. Speech became rough and nasal, the tongue 

 has become heavier, thicker and longer, so that it was often caught by the teeth when 

 she spoke. Formerly set of teeth was quite regular. At present the anterior incisor 

 teeth of the lower jaw incline outward, are spread apart from each other, and do not fit 

 those of the upper jaw. At first she suffered with constipation; often there was no 

 evacuation for fourteen days, latterly she often has diarrheas. She is very nervous, and 

 frequently has cardiac palpitations and difficulty in breathing. Slight tremor. The 

 powers of memory have suffered, the [mental] attitude is depressed and she is easily excited. 



Circumference of skull, 57.7 cm. 



Length of nose, 5.5. cm. 



