of the superior and
inferior maxillary bones. The latter often projects beyond the upper
teeth. The teeth become separated, and the soft parts increase in size.
The nose is large and broad, and the skin of the eyelids and ears is
enormously hypertrophied. The tongue is greatly hypertrophied. The
disease is of long duration, and late in the history the bones of the
spine and thorax may acquire great deformity. As we know little of the
influences and sources governing nutrition, the pathology and etiology
of acromegaly are obscure. Marie regards the disease as a systemic
dystrophy analogous to myxedema, due to a morbid condition of the
pituitary body, just as myxedema is due to disease of the thyroid. In
several of the cases reported the squint and optic atrophy and the
amblyopia have pointed to the pituitary body as the seat of a new
growth of hypertrophy. Pershing shows a case of this nature. The
enlargement of the face and extremities was characteristic, and the
cerebral and ocular symptoms pointed to the pituitary body as the seat
of the lesion. Unverricht, Thomas, and Ransom report cases in which the
ocular lesions, indicative of pituitary trouble, were quite prominent.
Of 22 cases collected by Tamburini 19 showed some change in the
pituitary body, and in the remaining three cases either the diagnosis
was uncertain or the disease was of very short duration. Linsmayer
reported a case in which there was a softened adenoma in the pituitary
body, and the thymus was absent.

Hersman reports an interesting case of progressive enlargement of the
hands in a clergyman of fifty. Since youth he had suffered with pains
in the joints. About three years before the time of report he noticed
enlargement of the phalangeal joint of the third finger of the right
hand. A short time later the whole hand became gradually involved and
the skin assumed a darker hue. Sensation and temperature remained
normal in both hands; acromegaly was excluded on account of the absence
of similar changes elsewhere. Hersman remarks that the change was
probably due to increase in growth of the fibrous elements of the
subcutaneous lesions about the tendons, caused by rheumatic poison.
Figure 283 shows the palmer and dorsal surfaces of both hands.

Chiromegaly is a term that has been applied by Charcot and Brissaud to
the pseudoacromegaly that sometimes occurs in syringomyelia. Most of
the cases that have been reported as a combination of these two
diseas