Reprinted from the Journal of Nervous and Mental Disease, November, 1894. 
Report of a Case of Acromegaly. 
BY 
\ 
RALPH L. PARSONS, M. D. The Alliance Press, 
134 AND 136 WEST 26th STREET, 
NEW YORK. REPORT OF A CASE OF ACROMEGALY.1 
DR. RALPH L. PARSONS. 
AB., the subject of this report, was born in 1858, 
# is a native of Westchester County and has al- 
ways resided in that county. 
His father died at the age of eighty years. He was 
always a healthy man. His mother died at the age of 
sixty-two, of some disease of the kidneys. He has three 
brothers, one sister and two half-sisters. All of these 
are healthy people. No hereditary predisposition has 
been discovered. 
During the first twenty years of his life the patient’s 
health was uniformly good, with the exception of dis- 
eases peculiar to childhood, from which he recovered 
without sequelae. 
Eighteen years ago, while residing on a farm in the 
country, he had an attack of ague and fever, but there 
has been no recurrence of malarial symptoms since 
that occasion. He knows of no other cause that may 
have injured his health, unless he may have been over- 
heated on one or more occasions about ten years ago 
while walking in the country. Has not been exposed to 
severe cold. 
During his boyhood he lived on a farm, was then em- 
ployed in a store, and for the past ten years has been 
employed as professional nurse. 
Says he does not remember ever to have had sexual 
desire, although he did practice self-abuse when a boy. 
On rare occasions has erections at night, but for the 
past ten years is quite certain that he has had no sexual 
desire. 
Has never had venereal disease. Has never used al- 
coholic stimulants. 
Ten years ago he was told that he stooped and car- 
ried his head to one side. Eight years ago he began 
to suffer from a pain, or as he would rather character- 
ize it, a distress in the back of his head. At first this 
occurred, for the most part, at night, and not oftener 
1 Read before the New York Neurological Society, January 2, 1894. 4 
RALPH L. PARSONS. 
than once a week. The distress seemed to be within the 
head. He would awake with a sensation of distress and 
of being dazed, would rise, bathe his forehead and back 
of his head with cold water, get relief, and then sleep 
comfortably for the remainder of the night. This symp- 
tom increased in severity and frequency, and has con- 
tinued until the present time, save as will be stated later 
on. Does not know of any cause for these headaches. 
He was occasionally constipated, but does not think he 
was especially constipated at the time of the occurrence 
of these headaches. Subsequently, they occurred by 
day more than at night. Latterly, they have continued, 
much of the time, during the forenoon, and have often 
been excruciating, almost unbearable in character. The 
distress, or pain, was usually most severe at the occiput, 
but would involve the left parietal and frontal regions. 
The right side of the head was unaffected. 
About six years ago his attention was called to the 
large size of his hands. He then for the first time per- 
ceived that his hands were of extraordinary size. Does 
not know for how long a time this undue increase in 
the size of his hands had been taking place. He had 
never been in the habit of wearing gloves. Does not 
think that he now wears larger shoes than he did ten 
years ago. Cannot say whether or not there has been 
an increase during the past six years. 
An examination of the patient was made on the 21st 
of October last and his physical condition and the ob- 
jective and subjective signs and symptoms of disease 
were found to be as follows, to wit: Weight, two hundred 
and twenty-seven (227) pounds; heart and lungs seem 
to be sound, but for some time past the patient has had 
shortness of breath when climbing a hill or walking 
rapidly; temperature normal; after sitting quietly 
for an hour his pulsations were found to be from one 
hundred to one hundred and five per minute ; appe- 
tite good, perhaps excessive ; urine not examined, but 
there seemed to be some degree of polyuria. 
Head.—Hair rather coarse, but natural in condition. 
Scalp healthy and free from dandruff. Left ear slightly 
thickened. Meatus of each ear normal; forehead retreat- 
ing; superciliary ridges quite prominent; no exophthal- 
mos ; malar bones rather prominent; cheeks appear 
rather sunken; nose rather broad and full at the nos- 
trils ; lips normal; tongue decidedly enlarged, obstruc- 
ting free articulation as though a foreign substance were A CASE OF ACROMEGAL Y. 
5 
in the mouth ; patient has himself observed this for the 
past two years; alveolar processes normal; teeth not 
separated ; chin elongated, especially on the right side ; 
head inclined strongly and habitually to the left side 
and forwards; patient says that he has carried his head 
in this way for the past ten years, and that he has a 
feeling of discomfort which is allied to pain when he 
does not hold his head in this position. 
Upper Extremities.—The hands are large and spade- 
like, the right hand being decidedly the larger; fingers 
large and sausage-like, but the extremities are de- 
ciededly smaller than the middle phalanges; the soft 
tissues of the hands and fingers are firm, full and resil- 
lient, without pitting on pressure, as though infiltrated 
by an elastic substance ; finger-nails appear small; sulci 
at the flexures of the hands and fingers rather deep; 
wrists appear to be rather large; arms normal; shoulder - 
large, but probably not abnormally so; left shoulder cars 
ried much lower than the right. The cubical content 
of the right hand about three weeks after the first ex- 
amination was 600 c.c., of the left 603 c.c. The method 
of estimating the cubical contents of the hands was by 
means of water displacement, as follows, to wit: A quad- 
rilateral opening was made in a thin board, the opening 
being large enough to admit the hand, one end of the 
opening being large enough to admit the turning of 
the wrist quite around and the other end too narrow to 
admit of such turning of the wrist. This piece of board 
was placed firmly on the wrist, as a clamp, by crowding 
the wrist far enough towards the narrow end of the 
opening; and then the hand was immersed into a 
beaker filled with water as far as the board would 
permit, the brim of the beaker having been first wetted. 
After the hand was removed, the displaced water was 
replaced and the quantity measured. 
Thoxax.—No abnormality of clavicles, sternum, or 
ribs noticed; marked kyphosis of the dorsum, with 
slighter scoliosis towards the left; lordosis slight, if any; 
heart sounds normal; pulse, on a repeated examination, 
one hundred; respiratory sounds slightly uneven or 
jerking. 
Pelvis.—No abnormality observed. 
Lower Extremities.—The feet are large, but perhaps 
not larger than in the case of many of his weight; but 
the tissues at the side of the foot near the heel, have the 
firm, resilient feel of the soft tissues of the hands. 6 
Skin.—Has perspired very freely for the past ten 
years ; and of late years the perspiration has been de- 
cidedly offensive, unless a special care was taken in his 
ablutions. 
Pain.—Mention has already been made of the head- 
aches. Has also suffered pain in the left ear; also in 
the left eye, especially after reading, or being in the 
sun. Consulted Dr. Webster two years ago on account 
of these pains, which it was supposed might have de- 
pended upon eye defects. Glasses were prescribed, but 
afforded no relief. The pains have been gradually be- 
coming worse until quite recently ; the headaches hav- 
ing often been excruciating in character and severity. 
Does not think his eyesight has ever been impaired, 
apart from the pain caused by use of the eyes. 
Sleep.—Disturbed by the pain in the head during the 
night; but after bathing the head would sleep for the 
remainder of the night. 
Senses.—Normal, save of the sight as mentioned. 
Bowels.—Formerly constipated, but regular for the 
past three months. 
Appetite.—Excellent, or excessive. 
Thirst.—Excessive. 
Mental Status.—Has not suffered from mental depres- 
sion since a boy, when he was at times depressed in 
mind. Intellectual processes rather slow, but otherwise 
normal. Memory unimpaired, save when suffering from 
headaches. 
Treatment.—On the 21st of October last, by advice of 
Dr. Starr, patient began the use of five drops, thrice 
daily, of an extract of sheep’s thyreoids. The medicine 
was kindly furnished by Dr. Crary. On the 4th of Nov- 
ember, the dose was increased one drop ; on the nth of 
November, to ten drops, and on the 22d of November, to 
fifteen drops, thrice daily. This dose has been continued 
until the present date. With the exception of tonic 
baths, general hygienic measures, and some restrictions 
in and regulations of the diet, no other treatment has 
been advised. 
Present Condition.—Patient reports that he has been 
feeling decidedly better since using the thyreoid ex- 
tract ; that his sense of well-being in general has im- 
proved ; that he feels more cheerful ; that he has more 
confidence in himself; that he now sleeps soundly 
through the night; or, if he awakes, that he does not 
need to arise on account of pain or heat in the head, as 
RALPH L. PARSONS. A CASE OF ACROMEGALY. 
7 
he formerly did ; that he can now read or write for con- 
siderable periods of time without causing pain in the 
head, or confusion of ideas; and that his headaches 
have been relieved to a very great extent, although they 
have not entirely disappeared. While they formerly 
occurred every day, especially during the forenoon, and 
were excruciatingly severe, of late they have been quite 
bearable in character, and on some days he is altogether 
free from headache. 
He has also improved in appearance and manner, but 
there seems to be no change in the dimensions of the 
hands. His weight has increased rather than dimin- 
ished. 
This case is of especial interest as bearing on the 
question of the usefulness of treatment by means of thy- 
reoid extracts. There can be no doubt that there has 
been great improvement in the subjective symptoms, 
but there may yet be a reasonable doubt whether the 
improvement depends more upon the direct action of 
the medicine, or upon the mental status induced by the 
fact that something is being done for the relief of the 
patient. 
Note.—August 6, 1894. Under the continued use of the thyreoid ex- 
tracts, patient has experienced great relief from his headaches, his gen- 
eral condition has improved, and there appears to be a diminution of the 
acromegaly.