EACIAL TYPES KEITH. 445 
and feet had altered so much in recent years that their best-known 
friends failed to recognize them. That incident marked the com- 
mencement of our knowledge of the pituitary gland as an intrinsic 
part of the machinery which regulates the shaping of our bodies and 
features. Dr. Marie named the condition " acromegaly." Since then 
hundreds of men and women showing symptoms similar to those of 
Dr. Marie's patients have been seen and diagnosed, and in every in- 
stance where the acromegalic changes were typical and marked there 
lias been found a definite enlargement or tumor of the pituitary body. 
The practiced eye recognizes the full-blown condition of acromegaly 
at a glance, so characteristic are the features of the sufferers. Nay, 
as we walk along the streets we can note slight degrees of it — de- 
grees which fall far short of the border line of disease ; we note that 
it may give characteristic traits to a whole family — a family marked 
by what may be named an acromegalic taint. The pituitary gland 
is also concerned in another disturbance of growth — giantism. In 
every case where a young lad has shot up during his late teens into 
a lanky man of 7 feet or more — has become a giant — it has been 
found that his pituitary gland was the site of a disordered enlarge- 
ment. The pituitary is a part of the mechanism v/hich regulates our 
stature, and stature is a racial characteristic. The giant is usually 
acromegalic as well as tall, but the two conditions need not be com- 
bined ; a young lad may undergo the bodily changes which character- 
ize acromegaly and yet not become abnormally tall, or he may be- 
come — although this is rarely the case — a giant in stature and yet 
may not assume acromegalic features. There is a third condition of 
disordered growth in which the pituitary is concerned — one in which 
the length of the limbs is disproportionately increased — in which the 
sexual system and all the secondary sexual characters of body and 
mind either fail to develop or disappear — where fat tends to be de- 
posited on the body, particularly over the buttocks and thighs — 
where, in brief, a eunuchoid condition of body develops. In all these 
three conditions we seem to be dealing with a disordered and exag- 
gerated action of the pituitary gland; there must be conditions of 
an opposite kind where the functions of the pituitary are disordered 
and reduced. A number of cases of dwarfism have been recorded 
where boys or girls retained their boyhood or girlhood throughout 
life, apparently because their pituitary gland had been invaded and 
partly destroyed by tumors. We shall see that dwarfism may result 
also from a failure of the thyroid gland. On the evidence at our 
disposal, evidence which is being rapidly augmented, we are justified 
in regarding the pituitary gland as one of the principal pinions in 
the machinery which regulates the growth of the human body and 
is directly concerned in determining stature, cast of features, texture 
