GIGANTISM 817 



childhood or before complete stature has been reached, and the growth 

 in consequence is more symmetrical and less strictly confined to the last 

 segment of the arches and appendages. In most cases, however, the 

 tendency appears to be for these last segments to grow in an unsym- 

 metrical and excessive manner." Finally in 1902 H. Meige stated: 



1. Acromegaly never precedes gigantism. 



2. Acromegaly sets in during the course of about one-half of the 

 cases of gigantism. 



3. When acromegaly is associated with gigantism the latter always 

 appears first. 



Meige added that when the disease commences in youth we get gigan- 

 tism, when in adult life, we get acromegaly, and when it commences 

 in youth and continues during adult life we get a combination of the 

 two. This formula is in the main correct but certain reservations must 

 be made. In exceptional instances typical acromegaly, without undue 

 growth in height, begins in early youth while the epiphyseal lines are 

 open. Likewise, certain giants who live beyond the growing period fail 

 to be "acromegalized." Cushing's careful case studies clearly bring out 

 the reason for the presence or absence of this transformation from simple 

 to acromegalic gigantism. It occurs only when hyperfunction of the 

 hypophysis continues after the cessation of growth. Such hyperfunction 

 is likely to be present for a certain period only and to be intermittent. 

 Later, hypofunction is prone to ensue but the acromegalic signs once 

 produced obviously remain permanently. 



Examples of Cases of Gigantism with Acromegaly. In the course 

 of the revision of all recorded cases of gigantism which followed Marie's 

 description of acromegaly in 1886 it was shown, particularly by Brissaud 

 and Meige, Woods Hutchinson, and Launois and Roy, that many, if 

 not most, of the earlier giants exhibited signs of acromegaly. This is 

 true of both of the famous "Irish giants," Cornelius McGrath (8 feet 

 6 inches) and Charles Byrne (8 feet 2 'inches), described by D. W. 

 Cunningham, both of whom had disproportionately large hands and feet, 

 prominent lower jaw and enlarged sella turcica. 



Among the early cases studied in America is that of a Bolivian In- 

 dian, Santos Mamai, 30 years old at death, reported by Dana, He 

 measured 6 feet 7 inches in height, weighed 300 Ibs., and had typical 

 signs of acromegaly: large jaw, hands and feet, enlarged thorax, kyphosis, 

 and greatly enlarged sella with hypophysis tumor. There was also a 

 general enlargement of the viscera (splanchnomegaly). Woods Hutchin- 

 son described a somewhat similar giant, 18 years old, from Minnesota, 

 decidedly acromegalic, as well as diabetic, and with hypophysis tumor 

 demonstrated at necropsy. The left eye was blind owing to complete 



