Nervous and mental diseases . g the opticchiasm and adjoining structures. It practically constitutes an endo-cranial tumor. Striimpell ^ 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 ^ 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 Striimpell ^ and reported byothers. In all cases the pituitary is diseased. 1 Deutsche Zeit f. Nerven
Nervous and mental diseases . g the opticchiasm and adjoining structures. It practically constitutes an endo-cranial tumor. Striimpell ^ 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 ^ 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 Striimpell ^ and reported byothers. In all cases the pituitary is diseased. 1 Deutsche Zeit f. Nervenheilk., 1897. 2 Centralblntt f. Nervenh., Dec, 1894. 3 Loc. cit. 510 NEUROSES. 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 bauds: A, Case of acromegalia; B, normal 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 SjDieen and lymphaticglands may be sclerosed; the thyroid is usually atrophic or goitrous; thethymus may persist and even be enlarged. It is to be noticed that,while parenchymatous glandular structures generally are atrophic,the pituitary is hypertrophic. Symptoms.—Among the most common symptoms of acromegaliawe may name hypertrophy of the face, hands,
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