242 ACROMEGALIA 



clear to me), and the true nature of the disease is conceived as a tumor-like 

 formation in the connective tissue which, as Erb and Ponfick have already 

 pointed out, resembles that of elephantiasis and also myxedema. It might 

 be more easy to ascribe the symptoms of the disease to the action of a specific 

 toxic secretion which, under normal circumstances, possesses an unknown 

 function, and which is present in the circulation in such slight amounts that 

 no deleterious effect is produced. I refer to the zymogen-like granules secreted 

 in the chromophilic cells which, in at least three of my cases, I found enor- 

 mously increased, while in the normal gland their action appeared of less 

 importance. I believe it may be strictly maintained that if there is a lessen- 

 ing of the normal supply of the bodies to the circulation they may affect the 

 activity of digestion as profoundly as the blood plasma as shown by recent 

 investigations. Hence an over-production of them may cause severe damage 

 to the tissues of the body. 



TREATMENT 



In conclusion I shall refer briefly to the therapy of the affection. I have 

 only negative points to report, since, up to the present time, it has been abso- 

 lutely without effect. Yet a knowledge of the pathology of the disease may 

 prevent error in the choice of therapeutic measures. The uncritical way in 

 which organotherapeutic " curative " results have been published led, as a 

 matter of course, to the production of hypophysis tablets and their admin- 

 istration to ^.cromegalics as soon as it became known that in acromegalia the 

 hypophysis appeared to be affected. Fortunately, it has been demonstrated 

 both by the use of these and by animal experiment that the administration of 

 the pituitary gland by mouth is quite harmless; we may assume that its 

 active constituents are rendered inert by the digestive fluids. Otherwise, we 

 would realize the unpleasant truth that this therapy must aggravate the dis- 

 ease by increasing the materia peccans. Until a hypophysis antitoxin is pro- 

 duced, the only rational treatment, based on the pathology of the disease, 

 must be the extirpation of the, hypophysial tumor. We cannot understand 

 why the hand of the fearless surgeon who has dared to attack the neighboring 

 Gasserian ganglion should halt at this operation. 



