Adolphe Roome III (1916–1967) was not an average 14-year-old boy.1,2 Standing at 6 ft tall and weighing 235 lb, he caused great consternation to his father, Dr Adolphe Roome II. Dr Roome, a former Los Angeles police surgeon, believed that his son suffered from a posterior pituitary disorder.3,4 Thus, he prescribed a pituitary extract to curb his son’s growth. Unfortunately, the son responded adversely to the therapy, complaining that he was “unable to concentrate” and refusing additional treatment.5 What ensued was a legal melee that persisted in the national newspapers for months. Filing a lawsuit in the Los Angeles Superior Court in late March 1931, Dr Roome sought to wrest medical custody from his ex-wife and former nurse Helen Roome, who supported her son.5 The New York Times, Los Angeles Times, and Time all covered the “fight over the juvenile giant.”6,7
At first glance, Adolphe’s story seems old-fashioned to 21st-century eyes. However, it has eerie parallels for present-day medicine. Modern pediatricians rely on growth curves as well as laboratory tests to determine which children are tall versus too tall. Indeed, this practice is a mainstay of contemporary pediatric endocrinology.8 The Roome saga highlights the tension that early 20th century physicians faced in defining the boundaries between these 2 categories. Through reconstructing Adolphe’s odyssey, we gain insights into the historical difficulties of evaluating the possible pathologic nature of adolescent growth.
Given Adolphe’s precocious growth, Dr Roome believed that his son’s tallness was pathologic, suspecting an endocrine disorder. He eventually diagnosed Adolphe with a “posterior pituitary dyscrasia,” fearing he would “ultimately develop into an obese giant, seven or eight feet tall and correspondingly heavy.”9,10 Charles Bennett, a Los Angeles endocrinologist and personal friend of the father, clarified that Adolphe suffered from “overactivity of growth principle” and “deficiency in the fat control principle.”4 Whereas Dr Roome couched his son’s diagnosis in glandular theories, Helen Roome harbored major doubts, insisting that her son was normal. Taking a more intuitive view, Helen pointed to the role of heredity in her affidavit: “his ancestors were of large frame and heavy and the boy’s father was overweight,” relying on her siblings’ testimony.7,9 She acerbically remarked: “The boy has every chance to become as much a man as his father—or a better one.”1 The court-appointed physician additionally stated that Adolphe was “gigantic but virtually normal.”5 It is worth noting that Helen’s perspective had some validity because of the etiologic uncertainty surrounding Adolphe’s growth (Figs 1 and 2).
Mrs Roome’s reservations were also reinforced by her fears of the not-so-benign available therapies. Dr Roome sought to halt Adolphe’s growth via injections of pituitarin, an extract of sheep pituitaries, perhaps derived from the posterior lobe.4,12 He foresaw the pathologic sequelae of abnormal growth and wanted to avert them. Likewise, Dr Bennett affirmed that the injections prevented gains in “flabby weight” and radiation would curb any additional height, if necessary.4 These were not the only options: a vast arsenal was at the ready, including neurosurgical procedures. Yet, Mrs Roome opposed medical intervention. At first, she did not object to treating her son, only to the side effects, some recognized as temporary by testifying physicians.7,10 Even more striking, Adolphe insisted he would rather be a “physical monstrosity” than an imbecile, an early 20th century term referring to the widespread concern about “feeblemindedness.”5,13
Ultimately, the courts would decide Adolphe’s fate. After Dr Roome expressed his wish for a “normal life” for his son, Judge Lester W. Roth initially ruled in April 1931 in favor of the father.6,14 Despite Dr Roome’s legal victory, Adolphe refused to cooperate and “defied” the court order by hiding in his mother’s house.15 Although much could be said on the subject of teenage autonomy in medical decision-making, that is a story for another day. By August 1931, Helen Roome became the guardian, and, to quote a newspaper article: “Adolphe Roome, Jr, “boy giant” is free to continue his natural growth.”16,17 Regrettably, Adolphe’s record is incomplete regarding the details of his physical examination and other relevant clinical findings. After the trial, he vanished from the public record, and when Roome died in 1967, he was without a diagnosis.2
To properly contextualize the Roome case, we must understand the then-nascent science of endocrinology. By the 1930s, much was known about hormones, “life’s master molecules”; yet, the pituitary exerted a magnetic pull on researchers.18 This preoccupation was part of a larger trend in which the fruits of the laboratory were demonstrating the value of scientific medicine to produce miraculous cures, including hormones and vitamins.19 In a 1932 review article, pediatrician Fritz Talbot12 cataloged the gland’s functions. Composed of 2 separate lobes, the anterior pituitary was responsible for “growth and sexual activity,” whereas the posterior involved water and fat metabolism.12 Since the late 19th century, autopsy studies and animal experimentation were used to confirm the anterior pituitary’s role in growth, although growth hormone was not isolated until 1944.20 Talbot12 also described multiple diseases of the anterior pituitary, including acromegaly and gigantism, framing these disorders as more relevant during adulthood. At the time of writing, tallness was linked to the pituitary, but no laboratory tests were available to definitively draw this conclusion.20 Finally, newspapers covering the Roome case concentrated on the posterior pituitary. This emphasis revealed anxieties about both Adolphe’s obesity and his tall stature.
Beyond hormones, growth charts played a pivotal role in the Roome case. Originating in 19th-century anthropometry, it was the chief diagnostic tool of its era. Seeking to correct abnormal growth or “defects,” physicians, starting in the 1890s, studied schoolchildren across demographics (eg, regions, races, classes) but primarily drew from the white middle class.21 By the mid-1920s, the Baldwin-Wood tables (the preeminent charts of their era) derived data from “middle class private schools.”22 Competing 1920s charts culled information from Detroit and Toronto’s populations.22 These charts served as a public health resource as well as a way for pediatricians to assert their professional authority.23 Often, these curves were used to idealize the average as normal, leading to vigorous debates on clinical standards.22 One 1929 chart epitomized the prevailing trends.22 In an article, the pioneering neurosurgeon and pituitary researcher Harvey Cushing11 plotted the average as well as a minimum-maximum pediatric height band. By examining this chart, a contemporaneous physician would have easily diagnosed young Adolphe as “overgrown.”11
Today, we are better able to determine if there is an underlying pathologic explanation for tall stature in children. Unlike the 1930s, one must document pathology via laboratory assays in addition to growth charts. In a recent review article, Meazza et al8 describe familial tall stature and constitutional advancement of growth as diagnoses of exclusion. They advanced the somewhat subjective criterion that if a child’s “predicted adult height” is 2.5 SDs above the population mean, then patients and their parents are free to decide whether to seek treatment.8 Adolphe’s story imparts a central message: the subjectivity of growth charts. Graphs and numerical data may appear objective, but their interpretation smuggles in cultural assumptions about normal height and sex. The “juvenile giant” may have eventually gone free, but we have not escaped his world.
Mr Schotland conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The author has indicated he has no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The author has indicated he has no financial relationships relevant to this article to disclose.