808 PETER BASSOE 



report is considered by Marie a case of pulmonary hypertrophic osteo- 

 arthropathy and not acromegaly. Machwitz briefly mentions acromegaly 

 in the 18-jtear-old son of an acromegalic and diabetic father of 46. H. 

 Salomon's fourth patient, a woman of 51 with typical acromegaly and dia- 

 betes, also reported by Schaffer, had a mother who probably suffered from 

 both of these diseases during the last four or five years of her life. Cyon 

 reports the disease in three sisters and Leva in two cousins. Cushing's(6) 

 case XXXI, a male acromegalic of large size, had a giant maternal grand- 

 father and his own three children were unusually large at birth. M. T. 

 Craft, a proven case of acromegaly, in his description of his own case 

 states that the giant Bates (see paragraph on heredity in gigantism) was 

 his paternal grand uncle. Goiter and diabetes in relatives are not infre- 

 quently mentioned, as is myxedema, Pope and Clarke described and pic- 

 tured an acromegalic father and myxedematous daughter. The patients, 

 themselves usually tall, often come of families made up of people above 

 average size. 



Pregnancy. As Erdheim and Stumme have proven the existence of a 

 physiological enlargement and overactivity of the hypophysis during preg- 

 nancy, it is not surprising that actual acromegaly occasionally is reported 

 as commencing during pregnancy. Marck reports as "pregnancy acro- 

 megaly" the case of a woman of 28 years during both of whose two preg- 

 nancies typical symptoms enlarged nose, fingers and toes, inability to 

 approximate the teeth developed and later subsided. Fehr reports an in- 

 stance of bitemporal hemianopsia without other signs, developing during 

 pregnancy and remaining stationary for ten years though the sella was 

 much enlarged (21 mm. long). In Gushing' s case XXIV, that of a 

 woman of 37 with 8 pregnancies, a tendency to enlargement of the hands 

 and feet was noted during three pregnancies prior to the establishment of 

 the disease. On the other hand, Goldstein (b) reports the development of 

 acromegaly within a year after removal of the uterus and adnexa for 

 myomata. This woman was of a coarse build so a predisposition was 

 thought to exist. 



Acute Infections. Gushing records previous pulmonary infections 

 and typhoid in some of his cases and comments on the tendency to rapid 

 growth following an attack of the latter disease in a young subject. In 

 one of his cases the onset coincided with that of tuberculosis of the cervical 

 glands. Others have reported acromegaly as developing after typhoid 

 fever (Ilecht, Messedaglia, and others), but most probably these are mere 

 coincidences, and the same is true of the cases reported as following alco- 

 holic excesses, coal gas poisoning, etc. 



Trauma. While basal skull fracture has been shown to have caused 

 symptoms of hypopituitarism with adiposity, probably from lesion of the 

 posterior lobe (Madelung, Gushing) the role of head injuries in connec- 

 tion with acromegaly, although several times alleged, cannot be considered 



