260 THE DISEASES OF THE HYPOPHYSIS 



the frequently observed polyphagia. Cunningham describes, in a case, a 

 doubling of the length of the small intestines. Also the kidneys are often 

 strikingly large, and in the urine a slight grade of albuminuria is not infre- 

 quently found. In two cases Fischer found enormous suprarenals, the en- 

 largement affected especially the cortex; also Delille saw this several times. 

 Lately Fischer and Schultze found enlargement of the suprarenals in two cases 

 of acromegaly, in one of which (a case of early acromegaly) the suprarenals 

 were enlarged about five times at least. Histological examination showed 

 that the suprarenals in toto were quite uniformly enlarged. Also the kidneys 

 were enlarged, showing on microscopical examination enormously large 

 glomeruli. 



In many cases the pancreas was found to be sclerosed, in other cases the 

 pancreas was found to have been entirely normal (see later the combination of 

 acromegaly and diabetes) . In many cases of acromegalic gigantism the pan- 

 creas were of quite enormous size (up to 270 gm., Launois and Roy). A per- 

 sistent thymus gland in acromegaly was already found by Klebs and Fritsche. 

 Since their time this finding has been reported very frequently (Dalton, 

 Arnold and others}; detailed references as to the literature can be found in 

 Borchardt (Deutsches Archiv fur klin. Med.) Pierre Marie regards the enlarge- 

 ment of the thymus as a reviviscence. The enlarged thymus may pro- 

 duce a distinct dullness over the upper half of the sternum, although nothing 

 should be concluded as to the enlargement of 'the thymus when this dullness 

 is found, as in acromegalics the sternum is often thickened enormously. 



The examination of the blood in acromegaly shows not rarely a reduction 

 in the number of erythrocytes and in the hemoglobin contents. This was ob- 

 served by Sabrazes and Bonnes. Messedaglia saw it in seven cases, Rotky 

 in five cases. In the cases reported above, the case Str (Observation 

 XXXI) had 4,700,000 red blood cells, 70 per cent, hemoglobin; the case Ta 

 (Observation XXVII), 4,900,000 red cells and 82 per cent, hemoglobin; 

 the case Ti (Observation XXV), 4,490,000 red cells and 95 per cent, hemo- 

 globin; the case Bo (Observation XXVI) 5,210,000 red cells and 85 per 

 cent, hemoglobin. Hence it seems that in the latter stages the erythrocyte 

 count and hemoglobin contents are reduced. 



The number of leucocytes is mostly normal (Rotky}, although there is 

 often found a somewhat reduced count. In my cases the case Ad (Observa- 

 tion XXVIII), showed 9800; case Bo (Observation XXVI) 8840; case Ta 

 (Observation XXVII) 5600; case Un (Observation XXIV) 6240, and finally 

 case Str (Observation XXXI) only 2900. 



In the majority of cases the differential count shows a mononucleosis and 

 not rarely an increase in the number of eosinophiles. Sabrazes and Bonnes 

 found this in two cases, Messedaglia in seven cases (30-37.8 per cent, lym- 

 phocytes), Rathy in five cases; Exner in one case found 39 per cent, mono- 

 nuclear cells and 61 per cent, eosinophiles. Likewise Franchini and Giglioli 



