230 ACROMEGALIA 



tant point, not brought out in the name, which must be borne in mind 

 if the pathologic process and the autopsy finding are to be accurately remem- 

 bered : It is not the size of the extremities which represents the most striking 

 symptom of the disease, as might be concluded from the name; it is the 

 enlargement, the abnormal, disproportionate growth of these parts. If 

 Cyrano de Bergerac, besides his celebrated nose, had had large hands and 

 feet, regarding which history probably gives no reliable reports, this would 

 not have been a sufficient reason for calling him acromegalic, provided he had 

 had these deformities from birth, or by heredity. In contradistinction to some 

 descriptions (even very recent ones) of "unquestioned" acromegalic symp- 

 toms in the bony skeleton, it must again be pointed out that the characteristic 

 symptom of the disease is not the unusual form of certain parts but their 

 advancing change, and that in any case in which anamnestic and clinical 

 data in regard to this symptom were absent only the existence of all the other 

 factors and the resemblance to the picture of acromegalia can be considered 

 presumptive evidence. This is a concession to clinical medicine which re- 

 quires a certain amount of self-denial on the part of the pathological anato- 

 mist, but the historical honor must in this case be accorded to the clinician 

 who founded the conception of the disease. 



By Pierre Marie's pioneer labors, by the long series of his thorough in- 

 vestigations and by those of his pupils, as well as by a great number of clinical 

 and pathological researches in which the most prominent scientists have taken 

 part, such an exhaustive description of the disease has been given that it 

 may almost be regarded as complete. Excellent comprehensive treatises, 

 among which those of M. Sternberg are to placed in the front rank, have dis- 

 seminated this knowledge throughout the medical profession. 



ETIOLOGY 



The tendency to this disease is an unfortunate prerogative of early matur- 

 ity ; one-half of all the known cases develop in the third decade of life. Less 

 frequently eases occur between the thirtieth and fortieth years, and a few 

 begin later; rarely has an onset before the twentieth year been observed. 

 Special stress must be laid upon the point that the disease, although usually 

 beginning after the body has attained its normal growth, nevertheless occurs 

 at a time of life when there is still decided plasticity of the body, and the 

 form thus presented must be separated from that of the true senile period. 



Both sexes are affected to the same extent, but in the cases that begin late 

 a decided predominance of women has been noted. The disease is quite rare. 

 I believe that, including the four typical cases upon which I held an autopsy,- 

 I have had more cases than any other pathologist. These are included in 

 about 8,000 autopsies which I have seen in a service of eight years in the 

 Urban Berlin Hospital ; curiously, three of these cases occurred in a period of 

 thirteen months from March, 1896, to April, 1897, and only one occurred 

 before or after this period. 



As may be seen from the previously mentioned observations of v. Langer, 

 there are obvious relations between acromegalia and giant growth since it 



