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PETEK BASSOE 



textbook, further observations are necessary to decide whether a sharp 

 distinction can be made between these two affections. 



Familial Hyperplastic and Deforming Ostitis. We choose this de- 

 scriptive term in connection with some much discussed and contested cases 

 which possess in exaggerated form the features of hyperplastic osteo- 

 arthropathy, also numerous and prominent exostoses, and changes in the 



soft parts. The onset is soon 

 after puberty, and there is no 

 primary disorder, such as dis- 

 ease of the lungs. Here belong 

 the famous Hagner brothers, 

 first described as "hyperostosis 

 of the entire skeleton" by 

 Friedreich in 1868. (Figs. 20, 

 21.) Later one of them was in- 

 cluded in Marie's first paper on 

 acromegaly but subsequently he 

 considered them as cases of hy- 

 pertrophic pulmonary osteoar- 

 thropathy, while Sternberg re^ 

 fused to classify them under 

 either head. Erb described 

 them as cases of acromegaly, 

 and Arnold, who examined the 

 older brother post mortem, left 

 the question 'open. In the ne- 

 cropsied case the sella was nor- 

 mal, the upper jaw, but not the 

 lower jaw, enlarged, and there 

 was increased growth of sub- 

 cutaneous tissue and of hair. 

 Recently Oehme has described 

 two brothers with enlargement 

 of the distal part of the 



extremities, with unevenness of the bones and numerous ogteo- 

 phyt.es, thickening of the shafts of the metacarpal bones, thickening 

 of the soft parts at the ends of the fingers and of the skin of the face, no 

 enlargement of jaw, nose or sella. The hairy growth was deficient. A 

 third brother and a sister were said to be similarly affected. As of more 

 distinctly endocrin type we may mention Eulenburg's case of "infantile, 

 familial muscle dystrophy with osteo-arthropathic deformations, 7 ' and the 

 family described by E. Kretschmer, several male members of which showed 

 enlargement of hands and feet, one with ununited epiphyses at thirty 

 years, tendency to arthropathies of the spine and knees, mental deficiency, 



Fig. 21. The younger Hagner. (After 

 \Y. Erlj, Doutsch. Arch. f. klin. Med., 1888.) 



