GIGANTISM 455 



acromegalic. Also Biedl has relegated the subject of gigantism to his 

 chapter on the hypophysis. 



Symptomatology and Types of Gigantism 



According to the opinions thus far existing in the literature, as to the 

 pathology of gigantism, it is not possible to define it uniformly. The 

 difficulty begins already with the question as to which individuals should be 

 regarded as giants. Bellinger proposed regarding as tall, human beings 

 whose height reached 205 cm., and only speaking of giants when the height 

 exceeded 205 cm. This classification is naturally quite arbitrary. Accord- 

 ing to it a whole group of the cases reported in the literature would no longer 

 be regarded as belonging to giants. Just as arbitrary seems to me the 

 opinion occurring in the French literature that only those giants that bear 

 acromegalic features should be regarded as true giants. Even though well- 

 proportioned, nonacromegalic giants are apparently among the greatest 

 rarities, yet, according to the definite statements of v. Langer and Virchow, 

 their existence is not to be doubted. Therefore it seems to me to the point 

 to adhere to the old classification of Langer and to distinguish between 

 normal and pathological giants. Moreover we find described in the literature 

 a group of cases, whose height lay between 190 and 200 cm. ; cases that showed 

 no acromegalic features, but on the other hand, all the signs of typical eu- 

 nuchoidism. Here, therefore, there lies before us all the signs of a potentized 

 form of eunuchoid tallness, and for this the designation eunuchoid gigantism 

 seems to me not without foundation. The cases coincide in part with those 

 cases which Launois and Roy have called infantile gigantism. Considering 

 the fact that I have sharply separated eunuchoidism from infantilism I 

 shall come back to this differentiation in the next chapter I must regard 

 the designation eunuchoid as more precise than infantile. I would here 

 point out that a portion of the giants described by Launois and Roy as in- 

 fantile are not pure eunuchoids, but already bear the acromegalic features. 

 Finally, as to what concerns the acromegalic giants I shall take pains to show 

 that here there are very diverse types, those types in which from the be- 

 ginning acromegalic manifestations are distinctly prominent; those types 

 which to use an expression of Launois and Roy " acromegalize " only later; 

 those types which possess the eunuchoid features or even pronounced eu- 

 nuchoidism from youth on; those types to whom a kind of late eunuchoidism 

 comes only later, and finally those types in whom the eunuchoid features are 

 entirely absent, in whom, moreover, the function of the sexual glands and 

 genitalia are entirely normal, or even perhaps temporarily abnormally 

 increased. 



In the great multiplicity of the manifestations of gigantism a uniform 

 exposition of the symptomatology is scarcely possible; it seems to me more 



