444 



Prof. E. A. Schafer. 



[July 22, 



propounded by Marie that the symptoms have been produced by suppression 

 of the internal secretion. But to this it may be replied that in such cases — 

 as, in fact, is not unfrequent in tumours of glandular organs — it is possible 

 to assume that the tumour at its beginning was non-malignant and of the 

 nature of a simple hyperplasia, the malignancy of character being estab- 

 lished later, and only then proceeding to destruction of the glandular 

 type of cell. 



The chronic character of the affection favours on the whole this supposi- 

 tion. For it appears to be established experimentally that complete 

 extirpation or destruction of the gland is incompatible with continuance of 

 life for more than a few days at the utmost. If we assume — which we are 

 not entirely justified in doing — that destruction by disease will have a 

 similar result, then we should expect, if acromegaly be due to hypertrophy 

 and increase of activity of the gland, that as long as such a tumour is merely 

 glandular and benign, the series of symptoms which characterise the disease 

 would gradually develop, and it is a known fact that in most recorded cases 

 it has pursued a slow course with a gradual development of the characteristic 

 signs. It is unlikely that at this stage the tumour which is forming is 

 already malignant, and especially that it has assumed a sarcomatous 

 character, which is that which has perhaps been most often described 

 post mortem in this disease. It is more probable that the malignant character 

 has become developed shortly before death, and by no means improbable 

 that death has resulted from entire suppression of the function of the gland 

 owing to destruction of the normal glandular cells by those of a malignant 

 nature. One must at the same time bear in mind the existence of other 

 possible causes or contributory causes of death, such as the pressure of the 

 tumour upon the base of the brain and the mere existence of malignant 

 disease. But in many cases the tumour has not been of sufficient size 

 to justify death being attributed to these causes, and the assumption that it 

 has resulted from destruction of the normal glandular tissue is probably correct. 



If the symptoms of acromegaly are due to an excess of secretion from the 

 gland, one would not expect amelioration, as the result of pituitary feeding. 

 Campbell Geddes (1908) mentions a case in which the patient became 

 rapidly worse when pituitary and ovarian extracts were given. In this case 

 the pituitary was 30 times the normal weight, and showed simple hyper- 

 trophy of the anterior lobe tissue only. There was no polyuria, although 

 this condition is often found either with or without glycosuria in both 

 acromegaly and gigantism. Its occurrence is best explained, as will be 

 presently seen, by supposing the posterior lobe, or, at least, the pars inter- 

 media, to participate in the hyperfunctioning of the anterior lobe. 



