148 WALTER E. DANDY and EMIL GOETSCH 



media as mentioned above — namely, at the relatively narrow area 

 of pars intermedia above the cleft, which elsewhere prevents 

 contiguity of pars anterior and pars posterior. Histologically 

 we should judge that this would be sufficient, especially in view 

 of the small fragment of anterior lobe which apparently will 

 suffice for the preservation of life. 



Naturally the final test of the practical efficiency of this col- 

 lateral must be determined by experimental operative methods. 

 Paulesco records cases of stalk separation which caused consequent 

 degeneration of the anterior lobe cells. One must, however, be 

 certain that this small collateral area of pars intermedia has not 

 also been destroyed by the operative manipulations, thereby pre- 

 venting the possibility of preservation by collateral. 



In a few operations on dogs by one of us (Goetsch), in which 

 the blood supply through the stalk was interrupted by the place- 

 ment of a silver wire ''clip" (equivalent to the hgation of the 

 stalk), no evidences of physiological deficiency or histological 

 degeneration of anterior lobe cells were observed 



In one of Dr. Cushing's hypophyseal operations for acromegaly 

 by a transphenoidal route it was intended merely to remove the 

 floor of the sefia turcica and to freely incise the dural pocket 

 enclosing the greatly enlarged gland, in the hope of thus reheving 

 the neighborhood symptoms. A fragment of the exposed anterior 

 lobe was removed for examination, and during the necessary 

 manipulations the gland was broken from its stalk and there was 

 a gush of cerebrospinal fluid, much as in an experimental canine 

 hypophysectomy when the gland is detached from its infundibular 

 connections. The patient died in forty-eight hours with symptoms 

 comparable to those seen in animals after a total hypophysectomy ; 

 and post-mortem histological studies showed an anemic necrosis 

 involving practically the entire pars anterior, whereas the pars 

 nervosa and its epithehal covering (pars intermedia) remained 

 normal in appearance, its individual and isolated blood supply 

 having been remote from possible operative injurj^ 



