852 PETEE BASSOE 



fright. The duration of the disease varies from a few years to fifty or 

 more. Victims of acromegaly have been known to reach the age of a 

 hundred yefers (Leri). In a general way, the later, and the more gradual 

 the onset, the more henign the case is likely to be. Most authors (after 

 Sternberg) distinguish an acute, malignant form, fatal in a few years, the 

 ordinary chronic form, fatal in eight to thirty years, and a benign form 

 which does not shorten life. Marked brain tumor symptoms and associa- 

 tion with severe diabetes or myocarditis are especially unfavorable. 



Treatment 



As the disease is subject to spontaneous arrest and prolonged remis- 

 sions great care is necessary in judging the value of the therapeutic agen- 

 cies employed. It is especially important to know whether active hyper- 

 pituitarism existed at the time a given treatment was given. Much be- 

 wilderment results if this point is not borne in mind. 



Methods of Treatment. Glandular Treatment. The use of prepara- 

 tions of the whole hypophysis or of anterior lobe is obviously contraindi- 

 cated during the active stage if the present views of pathogenesis are cor- 

 rect. The reported good results are to be explained on the ground that the 

 patients at the time of treatment had passed through the not infrequent 

 transition to a state of diminished glandular activity. Our hopes of the 

 discovery of a potent "hypophyseotoxin" or "antihypophysin" have not yet 

 been realized. Aggravation of the symptoms from pituitary treatment 

 should logically be expected, and has actually been reported ( J. Salomon, 

 Renon and Dellille). Salomon's patient who was made worse by pituitary 

 treatment improved on thyroid, and others have reported good results with 

 this gland (results compiled by Hinsdale) while on the other hand in- 

 creased weakness and glycosuria have been attributed to it (Sternberg). 

 Ovarian treatment to the extent of 5200 tablets was credited with great 

 subjective improvement and reduction in the size of the fingers by Bab, 

 who achieved still further success in his case by implantation of ovaries 

 from a case of osteomalacia. This is at least theoretically sound since 

 there is ovarian deficiency in acromegaly and since osteomalacia in many 

 ways is the antithesis of acromegaly. Kallecley reports return of menstrua- 

 tion and conception after three months of ovarian treatment. Potassium 

 iodide was long ago recommended because it had been useful in goiter and 

 good results have been reported (Sternberg, Fiirth). Altogether no con- 

 clusions can be reached as to the value of any glandular or drug treatment 

 up to the present time as the results are contradictory and the reported 

 successes subject to heavy discount on account of the laws of coincidences 

 and optimistic suggestibility in both physician and patient. 



Rontgenologic Treatment. The idea of diminishing growth and 



