The addition of new tissue goes on, as a rule, without pain, inflammation, or interference with function; but in a case of von Fischer’s, burning pain was associated with trophic ulceration; and Friedberg’s patient,[34] who appeared to be the subject of an associated elephantiasis Arabum, had symptoms that somewhat resembled the inflammation crises of elephantiasis.
In the majority of cases the functional power of the enlarged part is not augmented, but true unilateral hypertrophy, i.e., increased tissue hypertrophy with proportionally increased functional activity, is sometimes found. The cases described long since in general terms by Geoffroy St. Hilaire,[35] as marked by an unequal development of the two sides of the body in one or more regions, were probably of this nature, and those of Ollier, Finlayson, and Langlet, may also claim a place in the same class. In Ollier’s case[36] the face, thorax, abdomen, and both extremities of one side, were uniformly larger than the corresponding parts of the opposite half of the body, the vascularity of the hypertrophied side was increased, the temperature elevated, and the limbs were more powerful. There were no nævoid growths, and it is noteworthy that in association with an absence of evident abnormality of thoracic, pelvic, and abdominal viscera, the mammary glands preserved their symmetry. The cases of Devouges, Adams, and Finlayson, also presented certain points of resemblance to true hypertrophy. In the first the whole of one side was hypertrophied, except perhaps the abdominal wall, where nothing unusual was noticed. The details are very imperfect, but according to the patient’s statement, the strength of the arm on the hypertrophied side was greatly in excess of that of its fellow. In Adams’s case the giant growth of the right lower extremity was apparently uniform, and the femoral and all other accessible arteries were considerably enlarged, but nothing is said as to muscular power. In this as in the last example nævi were present. In an unpublished case of the author’s the hypertrophied hand was much stronger than its fellow; but in the example[37] already quoted there was no evidence of increased development of muscle. In two instances of unilateral hypertrophy of the face described by Friedrich[38] and Passauer,[39] the increased growth involved the whole of the parts of the affected side, even to the teeth and tongue, and in Friedrich’s patient, and in a case brought by Dr. Heumann before a Medical Congress in Darmstadt, the hair was more developed, and the secretion of saliva was excessive on the affected side, but the muscular power and arterial supply were not specially referred to. In a case of Eve’s the facial hypertrophy extended to the brain.
In the ordinary forms of congenital hypertrophy the size of the part is augmented by an unequally distributed hyperplasia of the skeleton and soft parts. Almost all the cases narrated in detail are of this kind. In nearly all, the arterial supply is proportionate only to the normal size of the part, and the functional capacity (power, sensibility, &c.), although not seriously altered, is to some extent deteriorated. The cases may be for practical purposes divided into two groups:
1. Without deformity, the enlarged segment preserving the normal contour in other respects.
2. With deformity.
a. From predominant development of the adipose or vascular tissues.
b. From secondary articular distortions.
c. From associated defects of development, as syndactyly, &c.
The condition of the different elements of the enlarged part is as follows:
The bones are always enlarged. Their general shape is commonly preserved, but occasionally their extremities are deformed by outgrowths at the line of junction with the articular cartilage. The hypertrophy reaches its greatest proportionate extent in the digits, while increase in size of the bones of the forearm, arm, leg, and thigh, is, as a rule, only demonstrable during life by admeasurement of length. No histological abnormality has been detected in the osseous tissue, but Eve (l.c.) found the cancellous tissue of the enlarged bone soft and the medulla fatty.