Nervous and mental diseases . Fig. 214.—1 and 2, Hand in acromegalia; 3, foot in acromegalia. Speech is frequently thickened from the clumsiness and voluminoussize of the tongue, and the voice is ordinarily very deep, strong, andrough, owing to the enlargement of the larynx, which to palpation mayappear of increased dimensions and unusual prominence. The organs of special sense may all be affected. Smell, taste, or hearingmay be reduced or abolished, but this is uncommon. Vision, however,is usually more or less affected eventually. This may arise from opticneuritis or from atrophy, and in eith

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Nervous and mental diseases . Fig. 214.—1 and 2, Hand in acromegalia; 3, foot in acromegalia. Speech is frequently thickened from the clumsiness and voluminoussize of the tongue, and the voice is ordinarily very deep, strong, andrough, owing to the enlargement of the larynx, which to palpation mayappear of increased dimensions and unusual prominence. The organs of special sense may all be affected. Smell, taste, or hearingmay be reduced or abolished, but this is uncommon. Vision, however, is usually more or less affected eventually. This may arise from opticneuritis or from atrophy, and in either case points to encephalic tumor.Amblyopia, blindness, intra-ocular pains, exophthalmos, contraction ofthe visual field, temporal hemianopsia, and miosis have been noted. The TROPHONEUROSES. 491 bilateral loss of the temporal fields or their manifest reduction indicatesinjury to the chiasm by the pituitary tumor. The muscular system may be normal or some atrophy may be found, but general muscular weakness is the rule. The