THE ANTERIOR PITUITARY AS THE ADRENAL CENTER. 221 



dia, with cure in some instances. Jaboulay, 61 in a subsequent 

 paper, referred to eleven personal operations, and had reached 

 the conclusion that removal of the superior cervical ganglion 

 gave the best results. As the upper ganglion is the origin of 

 the carotid plexus, we have again reached the anterior pitui- 

 tary. 



Some phases of the question, however, still require elucida- 

 tion. Why, for example, do the patients not succumb when 

 the bilateral operation is performed? It would seem, if the 

 anterior pituitary is the center of the suprarenal glands, as 

 if these organs should cease to functionate. Analysis of a 

 series of 61 cases, including 45 of epilepsy, 7 of glaucoma, and 

 8 of exophthalmic goiter, reported by Jonnesco, 62 suggests a 

 solution which coincides with deductions previously referred 

 to in this work. Idiopathic epilepsy, we have seen, is mainly 

 due to accumulation in the organism of toxic products of 

 metabolism, which give rise to sudden exacerbations of supra- 

 renal activity. To sever the connection between the two over- 

 active organs must evidently reduce the morbid phenomena 

 witnessed. Jonnesco, out of the 45 cases above mentioned, 

 "carefully followed" the subsequent history of 19; of the rest, 

 6 died, while the others were either too recent or had passed 

 from observation. Of the 19 cases, he says that "10 are cured: 

 that is, no spasms have occurred for two years in 5 cases, for 

 nineteen months in 1 case, for eighteen to fifteen months in 

 3 cases, and for six months in 1 case." He then adds: "6 of 

 those upon whom I have operated are decidedly improved; 2 

 absolutely unchanged. To sum up, 55 per cent, of the opera- 

 tions resulted in cure, 28 per cent, in improvement, and 15 

 per cent, were without effect/ 763 We thus have evidence that 

 a fair proportion of cases may be benefited by the operation. 



There is another side to this question, however. None of 

 the cases mentioned were operated before August, 1896, from 

 which month Jonnesco starts his series of 61 cases. The paper 

 in Medicine having been published in August, 1899, all the 



ei Jaboulay: Presse Medicale, Feb. 22, 1898. 



62 Jonnesco: Medicine, August, 1899. 



63 Given verbatim as translated by Dr. Willard Bartlett for Medicine, August, 

 1899. 



