THE SYMPATHETIC SYSTEM 173 



head," and four years afterwards in the theses of his pupil, 

 Louza-Leite, showed that it had some relation to disturb- 

 ances of the pituitary. 



SYMPTOMS. 



The general aspect of acromegalia is so characteristic 

 that the diagnosis is made on sight. 



The face as a whole is increased in its length and takes 

 the shape of an elongated oval. The forehead is low, the 

 supraorbital ridges prominent, the eyes small. The 

 nose increases in size in all directions and becomes enor- 

 mous. The cheek bones are prominent, while the cheeks 

 are sunken in. The ears are abnormally long. 



The lips, particularly the lower one, fall down; they are 

 thick and voluminous. The tongue is also involved in 

 the general hypertrophy: it is thick, large, long and 

 sometimes so swollen that it can hardly keep inside the 

 mouth, and interferes with swallowing. There is an 

 excessive development of the inferior maxillary; the chin 

 is stuck forward, increasing the deformity of the face. 



The cranium is very little changed. The anterior pos- 

 terior diameter is slightly increased. The external occipital 

 protuberance is voluminous. Radioscopic examination 

 shows an irregular thickening of the bones of the cranium, 

 an exaggerated development in height and in depth of the 

 frontal and maxillary sinuses, which explained the prom- 

 inence of the supraorbital ridges of the cheek bones. 



In the upper limbs, while the arms and forearms have a 

 normal volume, the wrists show a certain degree of 

 hypertrophy, but the hands have characteristic deformities. 

 They are large, thick and spade shaped. The develop- 

 ment is in the thickness and width of the hand and affects 

 both the bones, as shown by X-ray and the soft parts. 

 The hand appears to be padded. The fingers are short, 



