Nervous and mental diseases . tion of osteoblasts. The pituitary gland is enlarged and hypertrophic, filling up the dis-tended and enlarged sella turcica and commonly compressing the opticchiasm and adjoining structures. It practically constitutes an endo-cranial tumor. Strumpellx is inclined to think it an essential many cases it has been found to have undergone changes, probablysecondary in point of time and nature. Tamburini 2 believes the firststage is one of enlargement and increased function, followed by adeno-matous, sarcomatous, or cystic degeneration. A number of cases show
Nervous and mental diseases . tion of osteoblasts. The pituitary gland is enlarged and hypertrophic, filling up the dis-tended and enlarged sella turcica and commonly compressing the opticchiasm and adjoining structures. It practically constitutes an endo-cranial tumor. Strumpellx is inclined to think it an essential many cases it has been found to have undergone changes, probablysecondary in point of time and nature. Tamburini 2 believes the firststage is one of enlargement and increased function, followed by adeno-matous, sarcomatous, or cystic degeneration. A number of cases show-ing such degenerative changes are cited by Strumpell 3 and reported byothers. In the extremities and other portions affected by the hypertrophicenlargement the skin in its epithelial, dermal, glandular, and muscularparts is hypertrophically exaggerated. The connective tissue particu-larly is increased. The subcutaneous nerve-filaments are sometimes de-generated as a result of the fibrous hyperplasia, but this does not extend. Fig. 211.—Skiagraphs of hands: A, Case of acromegalia ; B, uorrual hand. into the nerve-trunks. The skin is frequently overactive and the per-spiration may be excessive and disagreeably fetid. In color the skin isusually muddy, especially toward the extremities, and frequently markedwith warts and pendulous, soft fibromata. The cutaneous sensibility ispractically normal, but these patients are usually very sensitive to mucous membrane of the nasopharynx, larynx, and tongue are simi-larly affected. The kidneys often show a moderate chronic parenchy-matous nephritis, with interstitial fibrosis. The spleen and lymphaticglands may be sclerosed ; the thyroid is usually atrophic; the thymusmay persist and even be enlarged. It is to be noticed that, while paren- 1 Deutsche Zeit. f. Nervenheilk., 1897. 2 Centralblatt f. Nervenh., Dec., 1894. Loc. cit. TROPHONEUROSES. 489 chymatous glandular structures generally are atrophic, the pituitary ishypertrophi
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