ACROMEGALY 819 



prominent, forming a smooth, rounded, bony overgrowth which overha 

 the superior orbital marg ln . The external occipital protuberance the 

 mastoid processes and the superior nuchal lines also show markedVny 

 overgrowth. The frontal, parietal and occipital bones show hypertrophy 

 wh lc h is greatest m their mfraial portions, while the squamous ration of 

 the temporal bones and the greater wings of the sphenoid show no hvper- 

 trophy and are thinner than normal. (Figs. 9, 10.) The under surfTce 

 of the base shows marked bony irregularities at the seat of muscular and 



,n Flg ; i H T nd f P atient shown in Figs. 2 and 3, as compared with normal hands. 

 (Case of Dean Lewis.) 



ligamentous attachments. The canals for nerves and vessels are not 

 reduced in diameter, but the foramen magnum is encroached upon and 

 made irregular by exostoses at its margin. The styloid processes are 

 elongated. A horizontal section of the skull shows thin external and 

 internal tables with marked increase in the thickness of the diploe both 

 posteriorly and anteriorly, and enormous dilatation of the frontal sinuses, 

 the floor of which is formed by the translucent part of the hypertrophic 

 superciliary ridges. The frontal sinuses measures 5 cm. from above 

 downward. 



A sagittal section of the vault shows a uniform thickness of 1.5 cm. 

 with thick diploe and thin tables. The internal surface of the vault is 



