A system of practical medicine . ptoms of the skin is hard and dry. The hair becomes brittle and falls out. There is very rarely any hypertrophy of the voluntary muscles metwith, except those of the hands and feet. The electrical reactions remainunaltered in uncomplicated acromegaly. The enlarged muscles mayundergo wasting after the disease has been in existence for some may be due to the develo])nient of some other aifection, such as pe-ripheral neuritis, syringomyelia, progressive muscular atrophy, or thewasting may occur independently of any gross change in the centra
A system of practical medicine . ptoms of the skin is hard and dry. The hair becomes brittle and falls out. There is very rarely any hypertrophy of the voluntary muscles metwith, except those of the hands and feet. The electrical reactions remainunaltered in uncomplicated acromegaly. The enlarged muscles mayundergo wasting after the disease has been in existence for some may be due to the develo])nient of some other aifection, such as pe-ripheral neuritis, syringomyelia, progressive muscular atrophy, or thewasting may occur independently of any gross change in the central orperipheral nervous system. It is rare to meet with any disturbance ofsensation. There may be actual enlargement of the eyeballs or an apparentatrophy of them from the marked increase in size in the brows andlids. The size and shape of the visual field are often considerablyaltered ; sector, hemianopic, and concentric limitation being met with indifferent cases. Optic neuritis going on to atrophy is present in a con- FiG. Right hand, palmar surface (Osborne). siderable proj)ortion of cases. Nystagmus and ocular paralysis are rarersymptoms. Tinnitus and deafness in one or both ears, due to middle- or internal-ear changes, are rarer symptoms than those of the eye above smell and taste may be found disordered. The speech is voice usually undergoes marked changes in acromegaly, owing tothe thickening of the tissues of the larynx. It is low-pitched and hasa disagreeable resonant clano;. Polyuria, peptonuria, glycosuria, and albuminuria are frequent com-plications. Pathological Anatomy.—In a considerable number of cases ofacromegaly proving fatal post-mortem examinations have been held, and 742 ACROMEGALY. exhaustive studies of the changes in tlie tissues made by men compe-tent by training and experience to cany out such work. The most painstaking study that I know of is that recently con-ducted by J. Arnokl. The case was at one time fully described
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