THE ANTERIOR PITUITARY AS THE ADRENAL CENTER. 223 



within six weeks, and the third from chronic nephritis eight- 

 een months after the operation. In one of Jaboulay's cases 

 death occurred the sixth day; the necropsy also revealed con- 

 gestion of the base of the right lung. Peugniez 65 also obtained 

 most satisfactory results, with every evidence of a permanent 

 and final cure, but a few weeks later the state of the patient 

 became rapidly worse, and death soon followed. 



In the light of the views advanced in the present work, 

 not only are the beneficial results obtained accounted for, but 

 the cause of the unusual mortality also becomes clear. Jon- 

 nesco's deaths during epileptic paroxysms obviously point to a 

 further increase of toxic waste-products: i.e., to their incom- 

 plete oxidation through the aggravated suprarenal insufficiency 

 caused by dissociation of the adrenals from their overactive 

 center. This very dissociation, on the other hand, in cases 

 possessed of less vulnerable adrenals, or of a less active pitui- 

 tary, accounts for the reduction of the abnormal suprarenal 

 activity to a normal level: a feature which also obtains in the 

 other disorders in which the operation has been employed. We 

 have excessive suprarenal activity in exophthalmic goiter, for 

 example, and if the operation does not reduce this activity 

 Mow the normal, a result that greatly depends on the con- 

 dition of the adrenals themselves, a marked and perhaps last- 

 ing improvement as regards the disease itself may occur. 



But the deaths during epileptic seizures, and the unusual 

 post-operative mortality due to intercurrent disorders, point to 

 a subsequent reduction of suprarenal efficiency and perhaps to 

 acquired vulnerability to the morbid effects of toxic agencies, 

 as a result of the operation. The "intercurrent acute diseases" 

 referred, to in Jonnesco's paper are not enumerated: a fact 

 suggesting variety and showing that no special disease (such as 

 "ether-pneumonia" occasionally observed when this anaesthetic 

 is employed) follows section or resection of the sympathetic 

 nerves. In the fatal cases referred to by Marchant, Jaboulay, 

 and Peugniez, grippal pneumonia, erysipelas, and chronic ne- 

 phritis appear as lethal maladies. These, added to epilepsy, 

 not only indicate the wide range of morbid conditions that may 



"Peugniez: Gazette Medicale de Picardie, Nov., 



