ACROMEGALY 841 



Thomas K. Davis as occurring in a case of arrested acromegaly in a man 

 of 28 years. After the disease had reached a disfiguring stage he became 

 unable to meet either strangers or old friends. "He has several times 

 broken down and cried in public places because there his thick lips and un- 

 shapen jaw, he feels certain, are the cause of unfriendly comment. He 

 shows deep emotion when telling any one of his trouble. He can initiate 

 no plans because his mind is lost in thinking of his affliction ; he has no 

 longer the ambition or the confidence natural to him." 



Pick's patient, a man of 47 years, whose brother was insane, had two 

 attacks, seven years apart, diagnosed "acute hallucinatory paranoia" from 

 which he recovered. With our present conceptions we would suspect that 

 the case was one of manic-depressive insanity on hereditary basis and 

 that there was no relationship between the psychosis and the acromegaly. 

 In a thesis on the mental state of acromegalics published in 1899 Brunet 

 collected six cases of insanity, namely, that of Pick, one of his own 

 and others reported by Tamburini, Thomas, Joffroy, Gamier and San- 

 tenoise. If he had perused the American literature he would have found 

 more. In 1891 Berkley reported a case in an insane colored woman, 

 60 years old, also claimed to be the first case of acromegaly observed in a 

 negro. Hutchings, in the annual report of the St. Lawrence State Hospital 

 for 1894, described a case of "mental enfeeblement in acromegaly" which 

 he reported more fully, and with necropsy, in 1898. The subject had 

 been arrested as a tramp in 1885 and was afflicted with a dementia which 

 gradually increased until his death in 1894. A tumor of the hypophysis 

 was present. Hutchings also relates a second case in a man of 44 years, 

 weak minded from birth, and epileptic from the age of seventeen. This 

 author commented on the fact that both of these patients were intolerant of 

 tight bands in the clothing which one of them said gave him a feeling of 

 suffocation and burning in the chest. This sensation and the delusion of 

 being suffocated by gas existed in an insane acromegalic woman observed 

 in an English asylum by David Blair. Worcester reported, with necropsy, 

 a case in a demented female inmate of Danvers (Mass.) State Hospital 

 who also had presented features of myxedema which cleared up on thyroid 

 treatment. 



Profound deterioration must have existed in the necropsied case of 

 Eltester and Schroeder, since the patient was described as demented and 

 apathetic, unable to feed himself or to speak any distinct words. In addi- 

 tion to hypophyseal tumor, the thymus, adrenals, and pancreas were en- 

 larged. In one of the cases reported by Harbitz, also with hypophyseal 

 adenoma and adrenal changes, dementia must also have been extreme, as 

 the patient, a woman, 28 years old at death, "became like an animal and 

 died an idiot," Such profound dementias occur with any kind of organic 

 brain disease, including tumor in various localities, and cannot be consid- 

 ered connected directly with the acromegalic condition. Alfred Gordon, 



