318 INTERNAL SECRETION 



single lobes or portions may be removed. This operation is very 

 rarely followed by haemorrhage. After operation, the elevator is 

 removed, the brain returns to its position, the dura mater is put 

 into place and kept there by the temporal muscles, and the incision 

 in the temporal cuticle is sewn up.- We found, in our experiments, 

 that Paulesco's resection of the zygomatic arch was unnecessary 

 and, provided that the openings in the squamous portions of the 

 temporal bones are sufficiently large, the structures in the sella 

 turcica may also be easily reached without such resection. 



What, then, are the results of experimental extirpation of the 

 hypophysis ? In order to arrive at a clear answer to this question, 

 it is necessary to consider separately the results yielded by the 

 older experiments, before the introduction of Paulesco's method. 

 In a large number of instances the animals operated upon by the 

 older investigators died either immediately or very shortly after 

 operation. Under these circumstances it was not possible to 

 decide whether death was due to the removal of the hypophysis, 

 or whether it resulted from the serious surgical intervention with 

 its attendant danger of infection. A small proportion of animals 

 survived for a brief period, one for three weeks, and some lived 

 even longer. It will be remembered that Lo Monaco and van 

 Rynberk destroyed their animals after thirty-five to eighty-six 

 days. 



The relative short span of life after extirpation was regarded 

 by many as a proof of the vital character of the hypophysis, 

 though other investigators, whose animals lived for longer periods, 

 ascribed the fatal termination to momenta other than suppression 

 of the organ. Lo Monaco and van Rynberk, especially, laid 

 great stress upon the fact that, after their transcerebral operation- 

 which was undoubtedly very drastic, seeing that it necessitated a 

 serious lesion of the infundibulum and the opening of the ven- 

 tricle their animals survived and showed no pathological sym- 

 ptoms. Single animals, with what the autopsy showed to be an 

 uninjured hypophysis, yet showed all the symptoms of hypo- 

 physis suppression ; while others again, in which the hypophysis 

 was found to be absent, remained normal. 



These contradictory views concerning the results of hypo- 

 physectomy are explained by the ill-defined and obscure nature 

 of the symptoms by which the operation was accompanied. In a 

 large number of cases, on the one hand, symptoms of depression 

 are described, ranging from dulncss and apathy to paralysis and 

 even coma; while in others, symptoms of motor stimulation, 

 fibrillary tremors and tonic cramps are reported; and in yet other 

 instances, no symptoms, either of stimulation or of depression, 

 were observed. The effects upon the vegetative nervous system 

 were also very differently described. Many authors found 

 polyuria, unaccompanied by abnormal constituents ; others describe 

 albuminuria; others again, glycosuria; while many were unable 

 to report changes in either the circulation, secretion, or respiration. 



