ACROMEGALT 849. 



this disorder affects bones and joints and is associated with pulmonary dis- 

 ease. As originally conceived the bony changes were attributed to stasis 

 and toxemia from obstructive disease of the lungs, but later cases have been 

 described z connection with disease of the heart, liver, and kidneys, and 

 elsewhere (carcinoma of breast, Kriiger), and without any discoverable pri- 

 mary disease (Becher). The terms "secondary hyperplastic ostitis" (Ar- 

 nold (a)) and "toxigenic osteo- 

 periostitis ossificans". (Stern- 

 berg) have been suggested as 

 more appropriate. However, a 

 survey of the case reports dur- 

 ing the thirty years which have 

 elapsed since Marie's discovery 

 shows that some form of pul- 

 monary disease has existed in 

 the great majority of the cases. 

 The importance of the vascular 

 stasis is emphasized in the ex- 

 cellent discussion of this condi- 

 tion by Janeway (1903) in 

 whose cases bronchiectasis ex- 

 isted. The mildest form of the 

 affection is constituted by 

 "drumstick fingers" (Trommel- 

 sMdgel finger) , first described 

 by Bamberger, in which at first 

 only the soft parts are enlarged 

 (clubbed fingers). Later peri- 

 osteal thickening appears, 

 which does not especially select 

 points of tendinous and liga- 

 mentous insertion as in acrome- 

 galy. Not only the hands and 

 feet but also the forearms and 

 legs become enlarged so the nor- 

 mal downward tapering of the extremities no longer exists. The nails are 

 very characteristic, being thick, long, brittle and curved like a parrot's 

 beak (papageienschnabelartig) . In the late stages the soft parts may be 

 actually atrophic. The existence of localized neuritis seems to favor the 

 hyperplastic changes as M6bius(&) observed extreme enlargement of the 

 last two fingers following ulnar neuritis in a patient with drumstick fingers 

 secondary to bronchiectasis. The cranial changes of acromegaiy are not 

 present. That the two conditions may occur together as has been shown by 

 Braun makes the matter more complicated, and, as Oppenheirn states in his 



perpiasti 

 Arch. f. 



20. The elder Hagner. Familial hy- 

 lastic ostitis. (After W. Erb, Deutsch. 



klin., Mud., 1888.) 



