ACROMEGALY 



257 



Distance apart of the alae of the nose, 4.2 cm. 



Circumference of the neck, 40.0 cm. 



Circumference of the waist, 86 cm. 



Height, 163 cm. 



Eye-grounds and perimetry normal. 



Second entrance, January, 1901. There now exist slight swellings of certain joints, 

 especially of the knee and elbows, where crepitation is present on palpation. The cardiac 

 oppression has become intense. The voice seems to have improved. The distance 

 between the middle and upper incisors is now about i mm., that between the lower middle 

 incisors 9 mm. The tongue is enormous; hands and feet have greatly broadened. The 

 tubera parietalia project markedly, and does also the arcus superciliares; alae of the nose, 

 the lips and lower jaw have enlarged enormously. The spinous processes are sensitive 

 to pressure. Pain in the entire vertebral column is elicited by pressure on the head. 

 Eye findings normal. The circumference of the throat has increased about 3 cm. 



Third entrance to clinic, January, 1903. Attacks of frontal headache with insomnia. 

 Alimentary glycosuria, a trace of sugar on the ingestion of 100 gm. dextrose. 



FIG. 46. Acromegalic and normal hands. 



FIG. 47. Acromegalic feet. 



Gynecological examination: Flat pelvis with very slight osteomalacic changes. Pain- 

 fulness of the bones, Chvostek's phenomenon positive l One time it was possible to elicit 

 Trousseau's sign. 



Flexion of the hip- and knee-joints much restricted. Spasms of the adductors. The 

 knee-joints greatly distended, crepitation. Electrical irritability normal. Eye findings 

 nornial. 



Erythrocytes, 4,278,000. 



Hemoglobin, 10.2 gm. 



Leucocytes, 2900, of which: 



Polymorphonuclear neutrophiles, 6 per cent. 



X-ray: Skull capsule thickened. Sella turcica irregularly widened, clinoid processes 

 hyperostotic. The thickening of the extremities affects the soft part exclusively. The 

 bones are atrophic. 



J On account of these manifold symptoms, the case was exhibited by A. M tiller before the 

 Wiener Gesellschaft f. innere Medizin und Kinderheilkunde. 

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