278 THE DISEASES OF THE HYPOPHYSIS 



the vessels, and the weak parts, there may everywhere be found hyperplasia 

 of the connective tissue. It is worthy of note in this case that the sella 

 turcica was not essentially widened, and that further there was a markedly 

 developed hairiness, especially of the extremities. Hence although in this 

 case the beginning of the affection occurred at the time at which normally 

 the epiphyses are not as yet closed, increase in height was not present in 

 this case. In this respect it seems to me significant that there were not 

 eunuchoid manifestations in this case; on the contrary, as was evinced by 

 the hairiness, rather was there an accentuation of the function of the inter- 

 stitial glands. 



A case of Claude's shows that in acromegaly the closure of the epiphysial 

 junctures may occur prematurely. It was that of a girl nineteen years old in 

 whom the acromegalic manifestations had gradually developed since the 

 fifteenth year. The epiphysial junctures were completely closed, and there 

 was no tendency to abnormal height. 



Very important is the case recently reported by Schultze and Fischer. 

 Here the disease began at the eleventh year of life. Since that time had ex- 

 isted headache, vomitings, and temporary salivations. The patient had 

 never menstruated. In the course of three days she became blind and 

 almost deaf (probably on account of narrowing of the inner ear on account of 

 osseous thickening). 



The girl was 167 cm. tall, weighed 81.5 kg. At various places there 

 were pronounced pigmentations, the skin of the entire body was rather dark, 

 from the navel there was marked development of the hair in the middle line, 

 also hair on the upper lip. At various places dark nevi. Inclination for 

 sweats. Head very long, horizontal circumference 59 cm. Upper lip mark- 

 edly cushioned, nose thick. Tongue enormously thickened, alimentary 

 glycosuria negative. Bilateral choked disc and atrophy. Death .manifestly 

 due to cerebral pressure. Pronounced obesity. Thymus hyperplastic. 

 General splanchnomegaly. Also the liver, kidneys, and especially the 

 suprarenal glands greatly enlarged (the last to five times their size). Uterus 

 small, infantile cysts of the ovaries, no formation of follicles. The tumor 

 of the hypophysis was of abnormal size (6.5 to 4.5 cm.). Microscopically 

 typical adenoma rich in cells. 



Schultze and Fischer regard this case as a mixed form between an ordi- 

 nary typical acromegaly and dystrophia adiposo-genitalis. 



Another type is found by the case described by Pel, a type that I herewith 

 describe in detail. The case was that of a sixteen-year-old youth. Since birth 

 the size of the hands and feet had been strikingly large and they gradually 

 increased in growth; especially of late, after a febrile affection, they have be- 

 come of enormous dimensions. In this increase in size the increase in the 

 dimensions of the individual bones of the extremities at the distal parts was 

 quite extraordinary. Thus the forearms were 29 cm. long, the circumfer- 



