1 ( J4 THE PITUITARY, THYROID AND ADRENALS AS A SYSTEM. 



that are capable of causing acromegaly, it would seem reason- 

 able to suppose that inordinate assimilation of the primary 

 elements and correspondingly excessive production would alone 

 account for the excessive growth witnessed. But this appar- 

 ently involves another conflicting feature, as against the many 

 theories in which disease of the pituitary is rendered respon- 

 sible for loss of function and resulting neuroses, auto-intoxica- 

 tions, vasomotor disturbances, asphyxia of extremities, etc.: 

 i.e., the need of overactivity of the pituitary and simultaneously 

 of the adrenals to satisfactorily account for the increased pro- 

 duction of cellular elements witnessed. 



Tamburini, 10 after an analysis of twenty-four cases in 

 which post-mortem examination had been made, concluded 

 not only that "in all typical 20 cases of acromegaly a growth of 

 the pituitary prevailed, but that there was at first hypertrophy 

 of the gland, with exaggeration of its functions and, later on, 

 abolition of these functions." 



Harlow Brooks, 21 after a careful study of the entire sub- 

 ject, refers to the feature in point in the following words: 

 "It is manifest that the only reliable key to the unraveling 

 of this rather chaotic mass of morphological alterations in 

 the hypophysis obscuring the pathogenesis of acromegalia is 

 on the basis of function." He then shows the solidity of this 

 view in the following lines: "By the process of elimination, 

 in the last chapter, the field of pituitary lesions was virtually 

 narrowed down to the second or hyperplastic class of changes, 

 and these are the true and essential lesions in acromegalia. 

 Besides the reasoning from the method of exclusion, there are 

 also positive data supporting this theory, for, in several cases, 

 observers have interpreted the results of their examination 

 of the pituitary changes as hyperplasia or adenoma. These 

 data furnish the key to disentangle the discordant observations, 

 and if we adhere to these results the subject seems clear. 



"Against the view of the increased function and hyper- 

 plasia theory, however, stand the observations of the cases of 



19 Tamburini: Rivista Sperimentale de Freniatrta, p. 559, 1894, and p. 414, 1895. 



20 All italics are our own. 



21 Harlow Brooks: Archives of Neurology and Psychopathology, vol. i, No. 4, 

 1898. 



