ACROMEGALY 261 



found mononucleosis in four cases, and among these hypereosinophilia in 

 two cases. Mendel in one case found even 18 per cent, eosinophilia. Also 

 Messedaglia and Rathy found for the most part an increase in the eosinophiles. 

 In my own case Ta (Observation XXVII) showed 76 per cent, neutrophiles 

 and 2 per cent, eosinophiles; case Da (Observation XXVIII) 74 per cent, 

 neutrophiles and 6 per cent, eosinophiles; case Bo (Observation XXVI) 

 63.8 per cent, neutrophiles and 2.3 per cent, eosinophiles; case Ad (Obser- 

 vation XXIX) 66 per cent, neutrophiles and i per cent, eosinophiles; case 

 Str (Observation XXXI) 60 per cent, neutrophiles; case Un (Observation 

 XXIV) 57.6 per cent, neutrophiles and 1.3 per cent, eosinophiles, and in 

 case Ti (Observation XXV) 56.7 per cent, neutrophiles and 0.2 per cent, 

 eosinophiles. 



Lately a report on the blood-findings in three cases has been contributed 

 by Borchardt. He found the erythrocytes approaching normal, the poly- 

 morphonuclear neutrophiles but little reduced, the eosinophiles mostly 

 increased. 



Hence the leucocyte count rather frequently shows, especially in the later 

 stages, a relative and perhaps also an absolute reduction in the number of 

 neutrophilic cells, and a relative increase in the large mononuclears; perhaps 

 this is the expression of a more or less well pronounced status lymphaticus, as 

 has been found in several autopsies. (Messedaglia, Schultze, Fi-scher, Rothy, 

 Claude and Baudouin, et al.). 



The anomalies of metabolism in acromegaly need a very exact exposition. 

 In many cases there exists obesity, as in the much-quoted case of Stritmpell, 

 although this was reported as- simply "layer of fat abundant." Lately 

 Schultze and Fischer have reported a case of early acromegaly who was fat. 

 Also the patient in Observation XXIX was fat. In a review of the literature 

 I have never found pronounced obesity. Frequently there exists voracious 

 hunger and polyphagia, relatively rarely lasting for long periods, and for the 

 greater part intermittent. Whether this symptom should always be re- 

 garded as a sign of hyperthyrosis, or whether it belongs to acromegaly proper, 

 I shall leave unanswered. 



Observations as to the exchange of gases in acromegaly have been carried 

 out only by Zantz-Geppert's apparatus (Magnus-Levy, H. Salomon, and the 

 recent investigations of Bernstein and myself}. I have summarized these in- 

 vestigations as follows: 



The investigations concerning the respiratory exchange of gases made up 

 to the present do not appear to decide with complete certainty the question 

 as to whether in acromegaly there occurs an increase in the caloric production 

 that may be ascribed to the disease as such. In the case of Magnus-Levy the 

 oxygen consumption and the production of carbonic acid doubtlessly are 

 appreciably increased. But just here, according to the statement of the 

 authors, there were present symptoms of hyperthyrosis that were not appre- 



