SYMPTOMS 233 



cavity of the eye, but to stasis in the sinus eavernosus, as might readily occur 

 from the pressure of a hypophyseal tumor. 



How many of the general nervous disturbances are to be referred to the 

 tumor, and how many to an independent disease of the nerves cannot be accu- 

 rately determined. But among other symptoms I must here refer to the 

 prominence of general nervous phenomena, such as pains, weakness, sensa- 

 tions of heat and the like. An important role is played by increased secre- 

 tion of sweat, polydipsia, and polyuria, which in many cases are probably 

 the sign of a co-existing diabetes. Occasionally, however, they certainly 

 occur without this condition. In the further course of the disease a conspicu- 

 ous loss of strength is observed, and nephritis and myocarditis often super- 

 vene, so that we find the picture of a severe general intoxication. Death results 

 in such cases either from paralysis of the heart or from bronchopneumonia. 

 A remarkable and frequent complication of the disease is diabetes, which, 

 for example, occurred in two of the four cases observed in the Urban Hos- 

 pital, and in one of the patients was the cause of death by coma. It is ques- 

 tionable whether the diabetes of acromegalics is to be ascribed to the pre- 

 viously mentioned symptoms of intoxication, or whether it is directly due to 

 the tumor of the hypophysis. I incline to the latter view, for in the two 

 eases in which the largest tumors of the hypophysis were found by us it was 

 present, and disease of the pancreas was absent. Not infrequently the tumor 

 of the hypophysis causes death by edema of the brain. Finally, in a disease 

 which runs such a slow course it is not remarkable that intercurrent afEec- 

 tions in no way related to the main disease frequently cause death. For 

 example, in one of our cases a perforating peritonitis, complicating cancer of 

 the stomach, led to the fatal issue. 



The symptoms most dangerous to life are the immediate effects of pres- 

 sure from the tumor of the hypophysis, and those which present the general 

 symptoms of intoxication. This is favored, as I may mention here, from 

 a clinical standpoint, by the great importance of disease of the pituitary 

 body, and also by the fact that in all the cases mentioned in literature in 

 which death occurred in a short time without any intercurrent affections, 

 the phenomena of the tumor of the hypophysis were most prominent in the 

 clinical picture, and the autopsy always showed an extremely large tumor. 

 Even though one may not agree with Sternberg's view that these cases are due 

 to a special type of tumor (see below in the account of .investigations by 

 Hanau and myself), the claim of Sternberg must be recognized that these 

 cases are to be differentiated as a " malignant " form of acromegalia. My only 

 objection is that Sternberg defines this differentiation by such an arbitrary 

 mark— the duration of the disease for four years. I do not doubt that at 

 least one of our cases, the case of A. Frankel, who after six years succumbed to 

 the disease without complications, must also be included in this " malignant " 

 group. Another of our cases of the same duration would also be included 

 here if we assume the fatal diabetes which existed in this case to be a symptom 

 of the tumor of the hypophysis, as I unquestionably do. It is somewhat arbi- 

 trary, therefore, to divide the other cases, as proposed by Sternberg, into an 

 "ordinary" and a "benign" form, as they may last thirty, or even up to 



