ACROMEGALY 847 



the hypophysis confirms the correctness of Gushing' s statement that thct 

 amblyopia associated with a primary atrophy more often represents a 

 physiological block to light impulses than an actual destruction of the 

 nerves. 



Epileptif orm Convulsions. These are not common and are usually ex- 

 plained by the increased intracranial pressure. Grinker's patient early 

 had attacks in which he "held his breath and snored" ; later, he had typical 

 grand mal attacks. The hypophysis tumor was large. Roubinovitch re- 

 lates a case with convulsions. The spinal fluid secured at that time would 

 cause convulsions in guinea pigs while at other times it was non-toxic. 

 "Uncinate fits" with gustatory aura are late symptoms of hypophyseal 

 tumor, and according to Gushing, are more frequent in states of hypo- 

 pituitarism, such as also occur late in the course of acromegaly. The 

 rontgenologic studies of the sella turcica in epilepsy by McKennan, John- 

 ston and Henninger are interesting in this connection as offering a possi- 

 ble explanation for the occurrence of fits in early cases with hypophyseal 

 and sellar changes but without pressure on the brain. 



Pain. Aside from the "pituitary" and general pressure headache and 

 the pains referable to the articular changes there are other and more 

 obscure pains. Thus, facial pains may be extremely annoying as in the 

 case of Mark ; there may be lancinating pains resembling those of tabes, 

 and acro-paresthesias. Sainton and State have made a special study of 

 pains in the extremities which they found present in 70 of 140 cases. 

 They ascribed them partly to root irritation by the frequently encountered 

 calcareous or bony placques in the spinal arachnoid. However, in view of 

 the frequency of such placques in various kinds of atrophic conditions of 

 the cord where pain is not a feature this theory is of doubtful value as has 

 been clearly shown by Leopold. 



Spinal Cord Complications. These have been made the subject of 

 special articles by Barrett (1906) and Petren (1907). Barrett reports a 

 case of old acromegaly in an insane woman of 51 years who was under 

 observation for several years at the Danvers (Mass.) State Hospital. Her 

 sallow skin and general debility suggested pernicious anemia but the blood 

 picture was practically normal. The knee reflexes at first were slightly 

 increased, but later absent. At the necropsy a hypophysis tumor was 

 found as well as marked degeneration in the cervical and upper thoracic 

 cord. It resembled that of pernicious anemia in the absence of involve- 

 ment of the posterior root fibers and Lissauer's tracts. Previously lighter 

 degrees of posterior column degeneration had been described by Schultze, 

 Duchesneau, Tamburini, Brooks, and Dallemagne. 



Petren devotes himself particularly to the relationship of syringomy- 

 elia to acromegaly and rightly points out the weak case made by those who 

 believe they have observed this combination. Usually the trophic changes 

 connected with syringomyelia have been mistaken for acromegaly. Petren s 



