• 1567
• Weiri, Johannes
• Medicarum observationumvararum liber unus.
• Basiliae per Jannem Oporinum MDLXVII
• Royal College of Physicians, 9 Queen Street, Edinburgh, EH2 1JQ
• cf Weinberg SJ 1931 pg 657/8
• Major finding of significance "no corpore menses"
• None

• 1779
• Nöel
• Sur un accroisement considerable des os dans deux personne adulte.
• Jour de Méd, Par. 51, 225
• Edin UL, George Sq, Edinburgh, EH8 9LJ
• Translation in Sammlung Auserlersener Abhandlungen für praktische. Aertze, xv, 541.

• 1801
• Saucerotte, Nicholas
• Accriossement singulier en grosseur des os d'un homme áge de 39 ans.
• Mélanges de Chirurgie 1: 407-411
• 
  
• Observation communicated to Academy of Surgery in 1772 (s.Virchow Gescwülste Bd II, S.24)
• Description of subject seen in 1772

Gall, Fj Spurzheim, JC 1818

Drawing of an acromegalic skull. Anatomical Atlas. Referred to by Patry FM 1908.

Alibert 1822

No source found for this publication in the UK.

Rayer, P 1823

Chevalier, TW 1827

Pathology of the Brian

Case 1. Aneurismal Tumour, situated between the Brain and Sella Tursica. By Thomas William Chevalier, Consulting Surgeon to the Royal Union Association, and Surgeon to the Westminster General Dispensary.

S.B. aetat. thirty-nine, a woman of masculaine form and robust constitution, applied to me on the 8th of October, when I obtained the following hislory of her case from herself and her mother: -- She had suffered from a severe burn at the age of fourteen, and had ever since complained of an unusual sensation, which she described as "a shaking movement in her inside." She had been more or less subject to headache from her infancy, and finally ceased to meustruate seven years since, without experiencing any inconvenience.

She had always been fond of reading, and indulged much in that amusement. Her circumstances obliged her to Iead an extremely temperate and laborious life; to which, however, she was cheerfully inclined.

About the month of May last, she first began to be afflicted with a strange sort of headache, very different from that to which she was previously accustomed, and a sensation of burning heat in the stomach, feeling (to use her own expression,) "as if her inside were on fire," and she frequently complained of the escessive heat of her mouth.

Those headaches, which were very severe, usually occurred more than once a week, and lasted, if at night, during two or three hours, but, in the daytime, usually for half an hour.

They were always preceded by fIushing of the countenance, and an increased sensation of heat, particularly in the region of the stomach, withonl any shivering or perspirations. They invariably commenced at the back of the head, the pain shooting through to the right eye, and generally producing oedema of the palpebrae. They were always relieved by the application of cold to the head, and they would at any time recur if she attempted to sit by the fire, or even to expose herself to the heat of the sun.

Her mother informed me that she often seemed to lose her recollection and conciousness for the space of a minute or two during these attacks, and that her health had appeared to decline from last spring, at which time they commenced.

About six weeks since, she remarked that she felt the same kind of "shaking or beating" in her head which until now she had experienced only in her stomach. f'rom this time her head was never entirely free from pain, and her sight became slightly impaired, so that she could not see to thread her needle; and about the same period, while walking on one occasion in Oxford Street, she found herself falling forward to the ground, and would have dropped had she not saved herself by taking hold of the railings. She presently recovered, and returned home, the distance of a furlong, witbout assistance.

Three weeks before she died, she fell upon her face in the street, and remained insensible for a few minutes; after which she was conducted home, with her usual headache. On Monday Octoher 11th, she consented, for the first time, to receeive medical advice, and accompanied her mother to my house, when I obtained the above account. I found that she retained the senses of hearing and smelling unimpaired, as well as her appetite; her sense of taste had heen deranged for months past, but this, proceeded, as she thought, from the heat of her mouth. Her countenance was now strongly marked with despondency, and she exhibited an air of stupid iudifference, which would have induced me to helieve her intoxicated or insane; hut. upon inquiry, I fonnd her intellect perfectly sound, and her hahits of life most abstemious.

Her pulse ninety-six, labouring, but not hard or full; tongue furred; bowels habitually costive; countenance florid. but as if chilled by cold. I prescribed a bluepill every night, and a compound, colocynth pill every morning, and ordered her to he cupped on the back of the neck to sixteen ounces.

On the following morning she was much relieved, and enlivened in her general appearance.

On Tuesday night, howerer, the pain in the head recurred with increased violence, accommpanied by sickness, and continued nearly all night.

In the morning I found her cheerful, and rather improved than otherwise in every respect. To take one ounce of Epsom salts tomorrow morning. and to continue the pills.

Ocloher 19th. --- She went to bed Iast night tolerably well. At half-past one o'clock. however, she got out of bed. and awaked her mother, who inquired what she was doing? to which question she replied, that she was opening the shutters to admit the light, because the room was so dark; whereas there was a candle burning in the room,and no shutters whatever to the window. Her mother arose in time to prevent her falling to Ihe ground, and replaced her in bed.

From this time she became comatose. and I was sent for in the forenoon. I found her perfectly devoid of intellect. but almost entirely deprived of sensation and voluntary motion; with a small, rapid, and labouring pulse: the feet cold: the pupil small and fixed; the countenance not in the least distorted; the breathing rather laborious, but not otherwise unnatural. She shrunk from the examination of the pupil, but evinced no other sign of senation.

To be cupped twelve ounces immediately, and a large blister applied to Ite back of the neck. Spirit lotion to the head; and an enema of compound of Colocynth and gruel as soon as possible.

At noon she appeared a little revived from Ihe cupping, and uttered a word or two upon being disturbed: her pulse had, however, increased in frequency, with scarcely any augmentation of its strength; and she died at one o'clock on the following morning, without having manifested any return of conciousness, or exhibited any other symptoms than those of pure coma.

Dissection. -- There were extensive cicatrices opon the arms, neck and chest. One side of the thorax was considerably depressed by a distortion of many years standing, but the Iungs were free from any unnatural adhesion, and every part of the trunk perfectly heathy.

On opening the head, the vessels of the meninges appeared rather turgid, and an extravasation of recent blood was found beneath the left parietal bone, between the arachnoid membrane and the pia mater, but its quantity did not exceed a table-spoonful, and was diffused over a circular space of three inches diameter.

The substance of the brain was unusually firm and healthy. The ventricles contained no more than about one fluid drachm of clear serum.

Upon raising the encephalon from the base of the skull, there was discovered a tumor of the size of a large walnut, attached to the pia mater of the base of the brain, and altogether inseparable without violence, from the sella tursica, so that an attempt was made to remove the adjacent bone, together with the brain, but without success, in consequence of the restraint which the presence of friends imposed. The soft parts being at length separated, the base of the tumor appeared to have filled the sella tursica, which was left clean by its removal, and its chief bulk had been situated so as to separate the corpora albicantia and the optic nerves more than an inch and a quarter from the posterior clinoid processes.

The tumor itself was nearly spherical, inclosed in a fine transparent membrane, excepting where it was cut away from the bone, and of so firm a texture that I was induced to believe it solid throughout. Upon cutting into it. however, after it had been macerated in alcohol for four or five days, I found it to consist entirely of coagula of blood, deposited in several distinct layers, which, like those of an aneurism, were paler on one side, viz. towards the bone, and softer as they approached the corpora albicantia, where there was a cavity as large as a filbert, containing recent coagulum.

With the utmost pains, I have been unable to detect any direct communication between the tumor and the adjacent arterial trunks: three or four comparatively minute branches of the left anastomosing artery of the circle of Willis are, however, so closely connected with its membranous envelope, that one of these may probably have furnished its contents. The preparation not having been injected, it is impossible to determine this point as accurately as might be desired. I hope, however, that the accoullt here given may not be altogether useless, as the symptoms described were sufficient to creale a suspicion in my mind from the first, of the true nature of the disease, and enabled me to fortel to a medical friend the result of the dissection with tolerable accuracy. 20, Soouth Audley Street; November 12th, 1827.

Todd, RB 1839

Abnormal conditions of the bones of the face

In Corvisart's Journal de Médecine the case of a Moor is cited, whose head and face were so enormous that he could not stir abroad without being followed by the populace.It is related that the nose of this man, who was half an idiot, was four inches long, and his mouth so large that he would bite a melon in the proportion that an ordinary person would eat an apple.

I have now before me the skull of a native of Shields who was remarkable during life for the length of his face; the entire head is large, but the bones of the face, and particularly the lower jaw, are enormously long. The abnormal development of the facial bones generally affects one jaw only, and more frequently the lower, as in the example just mentioned.

Magendie, M 1841

Leçons sure les fonctions et les maladies du système nerveux.

Une activité extraordinaire de la nutrition est en général liée à une état particulier du système nerveux. Etat particulier, c' est un mot. bien vague; mais je ne puis vous donner cette assertion que comme conjecturale et par conséquent vous me permetirez de ne point me servir de termes trop positifs. Toujours est-il que j'ai dans ce moment-ci à l'Hôtel-Dieu deux femines offrant à son maximum de développement cette maniére d'étre de l'economie qu'on est convenu d'appeler hypertrophie. L'une est une vraie femme-monstre. Tête, membre, tronc, tout a un volume énorme; sa langue a la largeur de celle du veau. ses doigts sont gros comme quatre des miens. Sa voix est celle d'un homme; les sons en sont graves, pleins: je ne doute pas que Ie larynx ne soit aussi hypertrophié. L'autre femme est dans le même genre, seulement elle a un peu moins d'ampleur. Comme elle est plus jeune, et que chaque jour elIe gagne davantage. je ne doute pas qu'avant peu elle ne puisse rivaliser avec son ainée. Rien d'ailleurs chez ces deux femmes n'explique cet accroissement énorme. Il est probable que Ia système nerveux y est pour beacoup.

Un fait incontestable c'est que la cessation de l'influence nerveuse amène des altérations profondes dans la nutrition, Vous verrez bientôt sur l'animal vivant la section d'un des nerfs de la cinquième paire être suivie de l'atrophie, du ramollissement, de la fonte purulente de toute la moitié correspondante de la face, tandis que l'autre moitié continue vivre, sans présenter la moindre lésion.

Ce n'est pIus seulement sur les autres orgnes, c'est sur lui-même que nous verrons Ie système nerveux influer. Ainsi tel nerf n'est pas sensible, isole est en realtion avec tel autre nerf. L'expérience directe prouve ces singulières dépendances. Irritez la septième paire, l'animal manifeste de lasouffrance tant que la cinquiéme paire est intacte: celle-ci a telle été coupée dans le crane, de manière que toute communication anastomotique soit détruite entre elle et la septième paire, vous aurez beau irriter celte septième paire, l'animal ne souffre plus. Ici donc la sensibilité ou l'insensibilité d'un nerf dépend de ce qu'il est ou de ce qu'il n'est plus en rapport avec un autre nerf.

Nous verrons aussi que bien qu'un nerf spécial soit affecté à chaque sens, il faut Ie concours d'un autre nerf pour que ce sens fonctionne normalement. II est dans ce cas fort difficile de faire la part de chaque nerf. Vous coupez la cinquiéme paire et l'animal a perdu I'ouie, la vue et l'odorat. Cependant les nerfs acoustique, optique et olfactif n'ont subi aucune atteinte. Ces nerfs ne sont donc pas exclusivement les nerfs propres de I'organe: iIs ne remplissent pas seuls Ies fonctions du sens dont ils ont reçu Ie nom. Peut-être même, et nous Ie vérifierons, Ie nerf olfactif n'accomplit-il pas relativement à I'odorat les usages qu'on est habitué à lui reconnaitre. Ce sera une question très intéressante à examiner de nouveau devant vous.

II n'est donc aucune fonction, aucun phénomène où vous ne retrouviez Ie système nerveux. Si nous comparans notre petit monde au grand, nous y reconnaissons la même harmonie, et alors, empruntant quelque chose à une pensée sublime, nous pourrions définir Ie système nerveux un centre dont la circonférence est partout.

II nous sera impossible de donner à ces études toule I'extension, tous les développements qu'elles comportent. Ce que je veux, c'est d'établir avec vous quelques propositions fondamentales basées
sur une saine physiologic. Si de là nous avons Ie temps de faire quelque excursion dans Ie domaine de Ia pathologie, nous serons d'autant plus en mesure que souvent dans les maladies vous reconnaîtrez la main de I'expérimentateur, dans l'homme qui souffre, I'animal chez lequel vous déterminez à votre gré de semblables souffrances. Une personne est frappée d'une hémorrhagic cérébrale. Elle perd certaine faculté. Quel est Ie point du cerveau qui a été atteint? Vous répondrez sans hésiter, et désignerez hardiment le siége de Ia lésion, si dans vos expériences du laboratoire, vous avez reconnu l'endroit qu'il faut blesser pour développer de semblables phénomenès.

Élevant plus haut vos prétentions, ne tenterez vous pas de connaître quels rapprochements on peut établir entre I'état du cerveau et certaines manières d'être de I'intelligence? Voici sur cette table Ie cerveau d'une femme aliénée; à côté est celui d'une femme morte avec toute la plénitude de sa raison; examinez, comparez, où est la différence? Permettez-moi une remarque. On se fait en général des idées fort inexactes de l'aliénation mentale en se la figurant comme un état permanent d'agitation et d'exaltation. C'est cependant le cas Ie plus rare. La plupart des aliénés sont mornes, taciturnes, dans un état d'affaissement général: ce n' est que par accès, alors que quelque chose a exalté leurs idées, ou évellé d'irritants souvenirs, qu'ils s'emportent, et que leur imagination s'exaspére. Meurent-ils dans cette période, vous trouvez la pie-mère injectée, la substance grise des circonvolutions parcourue par plus de sang; mais, prenez garde; cette congestion n' est qu'un effet. Elle n'a point appelé la folie, mais elle a été appelée par elle. Qu'un homme sain d'esprit, d'un naturel calme, soit pris d'une violente colère, et expire au milieu d'une exaltation extrême, vous retrouverez dans son cerveau les mêmes lésions que chez l'alièné. Sera-ce donc ici l'injection de la substance cérébrale qui aura provoqué cette espèce d'aliénation d'un moment?

Voici ençore une leçon toute consacrée à des généralités. C'est que Ie sujet est si abondant, qu'il nous enlraine; si vaste, qu'on ne peut l'embrasser ni Ie restreindre. J'espère cependant qu'à notre prochaine réunion nous pourrons vous donner quelques idées générales de la disposition et de Ia structure du système nerveux. 

Chalk, O 1857

Partial dislocation of the lower jaw from an enlarged tongue, Chalk O 1857. 

 Verga, A 1864

Negative to be scanned - Verga, A. Caso singolare di prospectasia. Rendiconti del Reade Instituti di Scienze Lettre di lombardo, Milano. 1864; 3: 111-7.

Friedrich, N 1868

Hyperostoses des gesammten Skelettes, Friedrich, N 1868. 

Lombroso, C 1869

Merkurürdiger Fall von allgemeiner hypertrophie (Macrosomia) oder scheinbarer elephantiasis, Lombroso, C 1869. 

Taruffi, C 1877, 1879 and 1881

Museum of Anatomical Pathology of Bologna. Number 593. Skeleton of acromegalic giant?

Brigidi, V 1877 and 1881

This case is described completely by Dr Brigidi of Florence including autopsy. He diagnosed it as Rheumatitis deformans and made a significant observation of a hypertrophied pitutitary gland together with the first microscopic examination of a pituitary tumour.

The case described is that of the actor Ghirlenzoni. Michel Casini, surgeon of Florence knew Ghirlenzoni after 1835 he was previously known for his romantic roles. He attempted to commit suicide in the Arno on 27th August 1875. He was carried to hospital delerious and lapsed into a coma.

Cunningham, DJ 1879

A large sub-arachnoid cyst involving the greater part of the parietal lobe of the brain.

Henrot, H 1882

Des lésions anatomiques et de la nature du myxoedéme, Henrot, H 1882.

Ellinwood, C 1883

Osteitis Deformans (case presented before the San Francisco County Medical Society)

This rare disease finds no place in our text-books. For its name and description we are indebted to Sir James Paget. In the case here presented for your examination we have a man of twenty-eight years of age, whose youth was delicate, without any hereditary disease known. At the age of 21 his weight was 93 pounds; at 26, his weight was 206 pounds, and now, at 28, his weight is 196 pounds. He has always been able to work. though at times he experienced muscular weakness, malaise and darting pains in the legs, and notably in the knees. His greatest trouble has been in mastication and dyspepsia.

About a year ago he found his lower jaw protrudiug beyond the upper, which gradually increased until he could not bite his food, and his lower teeth were extracted and a plate of artificial teeth substituted; this soon had to be replaced by another, and still the jaw continuing to elongate, the upper teeth were extracted, and artificial ones adjusted farther forward to fit tbe lower ones, and now you observe that the deformity is yet going on, and the lower teeth are projected nearly an inch beyond the upper. You observe aIso, the bones of the face widening, and, in fact, the entire skull has so enlarged as to require a larger hat, than a year ago. The bones of the trunk, the sternum and ribs, are enlarged, thickened, and the spine shows that deformity called lordosis, and for which he wears a jacket, with benefit from a support. The bones of the hands, the phalanges of the fingers, you see, are quite thickened, and yet flrm and strong. The whole skeleton is undoubtedly affected by the disease, while the head and short bones show it most. On getting out of bed in the morning his joints crack, and are badly adjusted, requiring considerable manipulation to get them to function properly. The man is awkward, and stumbles easily, from the imperfect use of his joints. He is anemic, and suffers very much from the cold weather; his hands become blanched, and his lips are pale, but less so now since his improved nutrition. He is quite free from cerebral symptoms, no headache, mind clear and memory good. His urine shows usually an increased quantity of urates only. At no time has this man had symptoms of acute arthritis.

So far as I can judge of the condition of the bones, they are not porous, they are not light in weight; they are symmetrically enlarged, and only the spine is curved, or its natural curves are greatly exaggerated.

Sir James Paget points out the marked features of other diseases of the bones which distinguished them from osteitis deformans, as in "rachitis, the bones are too small, too short, and have different curves from the elongated and thickened bones of this disaease; and in osteo-malacia they are thin and bent in an angular manner.

The treatment which I have adopted in this case is dietetic; a small allowance of histogenetic food, believing that we have a superabundance of such element in the bones, and giving him, a liberal diet of respiratory food, including cod-liver oil. His digestion has notably improved and his anemia is less marked, and his general condition has evidently improved with this change in diet. He now goes to the mountains for a time with the hope of further improving his nutrition, but we shall again, have him under observation when he returns.

Fritsche and Klebs, E 1884

Ein beitrag zur pathologie des resisenwuchs, Fritsche and Klebs, E 1884. Giant Peter Rhymer. 

Wadsworth, O 1885

A case of myxodema with atrophy of the optic nerves

It is only quite recently that the disease known as myxoedema has excited much attention; its pathology, beyond the fact that there is a deposit of mucine in the subcutaneous tissues, is still unknown; and even the symptoms observed in the cases reported have presented in some respects considerable variations. Although symptoms pointing to discturbance of the central nervous system have occurred in some cases, no affection of the eyes, in particular the optic nerves, has, so far as I am aware, been described. It may therefore be of interest to put on record the following case, in which there was atrophy of the optici. It may well be that the optic atrophy was only coincident, and had no direct connection with the myxoedema. Yet primary atrophy, as this evidently was, when it affects both eyes, is of comparatively seldom occurrence as an independent lesion.

Mrs C., aged forty-two, a large, strongly built woman, applied to me at the Boston City Hospital, June 27, 1884, because of failure of sight. She was in fairly comfortable circumstances, and since an attack of measles when fourteen years of age, had never been sick. She had been married twelve or fifteen years, but never been pregnant. Her catamenia had been regular till three years ago, when they ceased.

Some seven years ago her fingers and hands, and two or three years later her feet and lower part of her face, lips, nose and eyelids began to increase in size. The enlargement gradually became greater, and for a long time she had been obliged to have her boots made for her, being unable to find any large enough. Her speech became somewhat thick and slow, and her movements slower than formerly. Except for an occasional feeling of numbness in the parts affected, and of burning in the feet and legs, there had been no special discomfort. Of late, however, she had experienced slight dyspnoea on active exertion. Failure of sight was first noticed a year and a half ago, and had continually progressed. Careful inquiry both of her and her husband failed to elicit any history of pains anywhere. She had never had a headache. There had been no failure of intelligence or memory. Her appetite was good, bowels somwhat sluggish, micturition normal. She slept heavily.

The lower part of her face was full, heavy, of waxen hue, the natural folds obliterated; the lips full; the nose large, its alae broad and thick; the eyelids baggy. the hands and fingers were large and square, the thickening being most pronounced on the palmar surface, where the tissues could be pinched up in thick folds and gave the feeling as of an excessive development of subcutaneous fat. The feet were very large and broad, the swelling not extending above the ankles, and , although thre were large varicose veins of the right leg, there was no pitting here or elsewhere. The tongue was large and rather pale. The skin was not dry to the touch, but she stated that she never perspired. The thyroid was of normal size. Auscultation revealed nothing abnormal in heart or lungs. Temperature and pulse were normal. The patellar-tendon reflex was present. There was no significant anaesthesia of the skin. The urine was normal in every respect .

Examination of the eyes showed conjunctiva, cornea and iris to be normal. Movements good. R. only perception of light. L V. = 20/40; F. contracted in all directions, but to a much greater degree upward and outward. Media clear. In both eyes the discs were sharply defined gray with slight bluish tinge, without vascularity; the eeutral vessels, botb arteries and veins, small; in other respects tbe fundus normal.

Some weeks later the patient was admitted to the hospital, in the nervous and renal department, and remained for about a montb. During this time her general condition remained the same, but the vision of the left eye varied somewhat; on September 9 it was recorded as 20/70, but wben I saw her last, at tbe end of September, and a fortnigbt after she had left the bospital, it was 20/40 - 20/50. No farther symptoms had developed.

Read before the American Ophthalmological Society