462 PLTJRIGLANDULAR DISEASES 



the foreground, in gigantism the tendency to increase in function of the whole 

 ductless glandular system seems to belong quite to the essence of the disease. 

 It would seem that in addition to the hypophysis all the ductless glands are 

 involved in a predominant manner in the hyperplasia the suprarenal cortex, 

 probably also the chromamn tissue, etc. How enormous the pancreas may 

 become is shown by the autopsies of the giants Bassoe Peter and of the Tam- 

 bourmajor. The pancreas of the former weighed 275 gm., that of the latter 

 250 gm. Also the sexual glands may be involved in this hyperplasia. In 

 addition to this tendency to hyperplasia there exists, however, a lability, a 

 ready exhaustibility of the hyperplastic ductless glandular system; this 

 seems to affect the most readily the sexual glands, in which degenerative 

 processes may be established prematurely, indeed under circumstances the 

 sexual glands (and especially the interstitial glands which, indeed differ from 

 the other ductless glands in that they attain full maturity not until the time 

 of puberty) may be disturbed in their development from the beginning. 

 Also the development of the nervous system may suffer damage from this fact. 

 The monstrous eunuchoid giants are the most deficient mentally. In addi- 

 tion to the sexual glands the other ductless glands mostly rapidly show signs 

 of decay. The frequency of diabetes in youthful giants is known. In 

 the great decrepitude and muscular weakness perhaps there is involved a 

 degeneration of the chromaffin tissue. Even in the hypophysis, such de- 

 generative processes frequently occur, if the individuals attain a high enough 

 age. I refer to the case of Huchard and Launois in which the hypophysis 

 was found to be sclerotic, or to that of Gushing in which the hypophysis 

 was in great part converted into a cyst. How rapidly the decay can enter 

 in just these monstrous giants is shown by numerous cases in the literature. 

 The enormous muscular power of which these individuals were wont to be so 

 proud gives place in a few years to a great weakness. The ductless glandular 

 system has exhausted itself and the organism fades rapidly like a plant 

 driven to rapid growth by artificial means. Mostly the invalidism is rapidly 

 made an end to by an intercurrent disease. Woods Hutchinson tells of 

 eight giants that died on the average in their twenty-first year of life. 



Investigations of the respiratory metabolism of giants, as well in the 

 time of bloom as in that of decay, would be very important. I do not know 

 of any of them. With regard to the other metabolism investigations, there 

 are only the statements of Lem and Franchini, who in one case found increase 

 of the elimination of amino-acids, ammonia, and neutral sulphur. 



On the basis of what has been said above, I would assume in gigantism 

 an abnormal mapping-out [Anlage] of the whole ductless glandular system, 

 and would not, as have other authors, simply include it in the chapter on 

 acromegaly. We know indeed that there are other forms of gigantism 

 setting in in early life in which not the hypophysis, but other ductless glands 

 (the epiphysis, the suprarenal cortex, the sexual glands) occupy the chief 



