A case of acromegaly / by W.B. Hadden and C.A. Ballance.

  • Hadden, W. B. (Walter Baugh), 1856-1893.
Date:
[1888]
Catalogue details

Licence: Public Domain Mark

Credit: A case of acromegaly / by W.B. Hadden and C.A. Ballance. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    on hypertrophy of the nasal cartilages and of the tissues over them, the nasal bones being unaffected. The enlargement of the upper and lower jaw-bones is uniform, and seems to be due to simple hypertrophy. The skin of the face, though pale, presents no obvious alteration. Beneath the eyes there Is distinct fulness, but no unusual pallor or translucency, and the circumscribed redness, so commonly seen in myxcedema, is absent. The cranium is natural, and the woman asserts that she has not been obliged to alter the size of her bonnets. The neck is full and short, the subcutaneous tissue over-abundant, and beneath the chin there is a pendulous, soft mass, probably fatty. No enlargement of the submaxillary glands can be detected. The thyroid gland is not to be felt; but it cannot be said with certainty that it is atrophied, since palpation is difficult in consequence of the fulness of the neck. There is slight fulness above the clavicles, and these bones are much curved, and distinctly larger and thicker than normal. We shall now proceed to describe the most striking clinical characters of this condition, and we may here remark that the name Acromegalic (uKpov, extremity ; /uLtyaXr), large) was suggested by Marie in consequence of the remarkable enlarge- ment of the hands and feet. In our patient the hands are gigantic, though in no way deformed. The hypertrophy appears to be general, but the subcutaneous fatty tissue is probably disproportionately thickened, especially along the inner border of the hand. This overgrowth of fatty tissue is noted in one of Marie's cases. The metacarpal and phalangeal bones are large; their outlines natural. The skin of the hands is moist and in every respect natural; the wrinkles are present on the backs of the fingers. The nails are large and broad, not otherwise affected. Formerly the patient used to wear No. 7 gloves. The measurements are now as follows :— Circumference at metacarpophalangeal joints : right hand, 9g inches; left hand, 9£ inches. Circumference at centre of metacarpal bones : right hand, 9^ inches; left hand, 9| inches. The right middle finger is 4£ inches long; the left 4| inches. Broadly put, we may say that the increase in the circumfer- ence of the hand is 2\ inches. There is no enfeeblement of the grasp, and the woman says that she can use the hands, even for threading a needle, as well as ever she did. The enlargement of the feet is in proportion even greater than that of the hands. She used previously to wear laro-e 4 boots, afterwards large 6, and now she wears large 8. At the root of the toes the right foot is 10£ inches in circumfer-