376 THE DUCTLESS GLANDS 



From osteitis deformans and from arthritis deformans it may be 

 distinguished because the enlargement is general, instead of 

 affecting only the shaft, as in osteitis deformans, or the cuds, 

 as in arthritis deformans. In osteitis deformans, too. as 

 pointed out by Marie, the face is triangular, with the base 

 upward, while in acromegaly it is ovoid, with the large end 

 downward. In congenital progressive hypertrophy, or " giant 

 growth," only one limb becomes affected, and the shaft of the 

 bone is involved. 



But the differential diagnosis from certain diseases of the 

 nervous system, and in particular from syringomyelia, is stated 

 to be sometimes very difficult, or even impossible. 



In affections of the spinal cord enlargements of the extremi- 

 ties are liable to occur, and especially is this true in syringo- 

 myelia. Fischer gives several examples from Schlesinger and 

 others. It is stated that syringomyelia may give rise to the 

 typical clinical and anatomical features of acromegaly. If 

 this is true, then it will be absolutely impossible in certain 

 cases to make a correct diagnosis during life, and it must 

 have frequently happened that cases of syringomyelia have 

 been described as " acromegaly without tumour of the pitui- 

 tary." The suggestion has been tentatively put forward 

 that the hypersecretion of the pituitary may, after all, pro- 

 duce the condition of acromegaly by action upon the nervous 

 system. 



The prognosis is bad, and all treatment hitherto attempted 

 seems to be without avail. Naturally, treatment with pituitary 

 preparations has been tried. This, of course, has been done 

 on the hypothesis that acromegaly is due to diminished action 

 on the part of the gland. The results are unsatisfactory, and 

 even definitely unfavourable results were sometimes obtained. 

 No reduction can be effected in the size of the extremities by 

 internal administration of the gland. Magnus-Levy records a 

 case of acromegaly treated with pituitary substance. Symp- 

 toms arose which recalled features of Graves's disease marked 

 perspiration, polyuria, and alimentary glycosuria. 



It seems, from all that has gone before, that the only rational 

 treatment for acromegaly is a partial extirpation of the pitui- 

 tary body. This was first definitely suggested by Victor 

 Horsley, and has been extensively carried out by Gushing and 

 others. 



