Volume 1
A text-book of the theory and practice of medicine / by American teachers ; edited by William Pepper.
- Date:
- 1893-1894
Licence: Public Domain Mark
Credit: A text-book of the theory and practice of medicine / by American teachers ; edited by William Pepper. Source: Wellcome Collection.
885/962 (page 863)
![cases, and the outbreaks may be definitely connected with indigestion or with overeating. Local treatment is not of much value. When the oedema is very great and the tension painful, careful puncturing gives relief. Acromegaly. Definition.—An affection characterized by hypertroj)hy of the hands, feet, and face. The name, which signifies large extremities, was given by Marie of Paris. Etiology.—The condition occurs more frequently in women. Of 38 cases in the monograj)h of Sousa-Leite, 22 were in women and 16 in men. The aflection begins, as a rule, at about the twenty-fifth yeai-, occasionally earlier, in some instances as late as the fortieth. It has no apparent connection with sexual processes. Heredity has apparently played a part in some cases. Syphilis, the specific fevers, and rheuniatism have occasionally preceded the development of the disease, but probably have no special connection with it. In this country only a few cases have been I'cported. Symptoms.—A well-marked case presents a very characteristic a])pcarance. (See Plate III.) Tlie hands and feet are enlarged, the increase in size involving both bones and soft parts and giving a spade-like character to the hands. The wrists may be enlarged, but the arms ai'e not otten affected. The feet are uni- formly enlarged, and the size of the big toe has been in some cases out of ]Uo- portion to the others. The nails are usually broad and large and vertically grooved. Although tliey look clumsy and unwieldy, the hands can be used freely, and even such a delicate operation as threading a needle can be well performed. The long bones, as a rule, are unaffected, but in some instances there has been thickening of the extremities of the fenmr and of the tibia and the fibula. The enlargement involves the liead and face, particularly the latter, whieh becomes elongated and bi'oadeiied in consequence of the increase in size of the superior and inferior maxillary bones ; the latter in particular increases, and may ])roject beyond the up])er jaw. The idveolar processes become greatly thickened and the teeth are scjiarated. The lower lij) is thickened and the ears greatly hypertrophicd. The tongue has in some instances been greatly enlarged. Increase in tlie size of the bones of the skull may be ]>resent. The neck looks short and tliick, chiefly on account of the elongation and depression of the chin. Tlie skin may look normal or is coarse and flabby. It rarely has the harsh a}ipearance of myxcedema, and the subcutaneous tissues are not infiltrated. The bones of the thorax may slowlv and jirogressively enlarge, and in a late stage of the disease the spinal column may l)c involved and there may be marked ky])hosis. The clavicles and sternum may also increase in size. The muscles are sometimes wasted. The genitalia have sometimes been hypertrophicd. The thyroid has been normal in some cases, atrophied in others, and in a third group enlarged. Erb has noticed an area of dulness over the manubrium sterni wdiich he thought to be possibly due to persistence of the thymus. In women menstrual disturbance may be an early feature, and tliere may be com-](https://iiif.wellcomecollection.org/image/b20413920_001_0885.jp2/full/800%2C/0/default.jpg)
