454 PLURIGLANDULAR DISEASES 



individual symptoms under the influence of these, yet the progressive 

 cachexia can for the most part not be essentially influenced. 



Gigantism 



Historical. It can be readily understood that gigantism usurped the 

 interest of the laity and physician from early times. Indeed a philanthropist 

 even founded a prize in order that by the intermarriage of giants a larger 

 and stronger race would be produced. For the first valuable scientific obser- 

 vations concerning this interesting phenomenon we are indebted to C. 

 v. Langer. v. Langer distinguished between normal and pathological giants. 

 He described three skeletons of normal giants, one from the Berlin Patho- 

 logical Institute, one from Hunterian Museum, and one from Trinity College, 

 Dublin. These giants enjoyed good health until a high age; they showed in 

 general normal dimensions of their skeletons corresponding to their size, 

 therefore rather large skull and a relatively large upper body, the upper 

 length somewhat exceeding the lower length. In the other group, the 

 pathological giants, v. Langer first pointed out that here certain pathological 

 alterations of the skeletons were present, such as relatively small cranium 

 with enlarged sella turcica and enlargement of the facial skeleton with enor- 

 mous lower jaws, widening of the pneumatic spaces, increased development 

 of the insertions of the muscles, certain abnormalities of the pelvic girdle, fre- 

 quency of genu valgum, in short a series of alterations that to-day we would 

 designate as acromegalic. v. Langer pointed out that from illustrations also 

 degeneration of the soft parts, such as enlargements of. the tongue and the 

 lips, had existed. 



Then Sternberg in a detailed work pointed out the frequency of the com- 

 bination of acromegaly and gigantism. According to Sternberg about 40 

 per cent, of all giants are acromegalics, and about 20 per cent, of all acro- 

 megalics giants. This question entered upon a new stage when especially 

 the French school sought to define the relation between acromegaly and 

 gigantism. After Massalongo had designated acromegaly as late gigantism, 

 Brissaud and Meige came forward with the teaching that acromegaly and 

 gigantism are one and the same disease and depend on the same cause, 

 namely, an alteration of function of the hypophysis, which leads in youthful 

 individuals to gigantism, and in older individuals, those in whom the epi- 

 physial junctures have already ossified, to acromegaly. These authors also 

 support the view that only the acromegalic giants should be termed proper 

 giants, and that gigantism should always be regarded as the disease. This 

 opinion, which was actively contradicted by Pierre Marie, Launois and Roy 

 have tried to support in several researches and in their monograph. 

 These authors show, in convincing fashion, that the greater part of the 

 giants thus far observed have been acromegalics, or have later become 



