512 THE POSTERIOR PITUITARY AND THE NERVOUS SYSTEM. 



in the later stages, by causing insufficiency of these organs. 

 In a previous chapter we have and correctly we now see 

 ascribed to overactivity of the adrenals the stage of "erethism," 

 and to insufficiency of these glands that of "cachexia." But, 

 if we ask how these states are produced by the adrenals, the 

 answer which would not have been available before now seems 

 to be within our reach. 



We have previously referred to the vicious circle that ob- 

 tains in acromegaly. Though primarily located in the anterior 

 pituitary, the lesion probably gives rise to no untoward symp- 

 tom until well advanced: i.e., until pressure occurs either upon 

 its own structure by the pathological elements or upon the 

 posterior pituitary. Even slight pressure upon the whole organ, 

 as shown by de Cyon, 16 gives rise to typical suprarenal symptoms. 

 But if the posterior pituitary is also considered as a factor in 

 the production of the symptomatic phenomena, as a source of 

 nervous energy, we not only have the vascular erethism of 

 suprarenal overactivity, but distinct evidence of nervous ere- 

 thism besides. This is well illustrated by the following quoted 

 lines, i.e., Gauthier's definition of the erethic stage of acro- 

 megaly as given by Hinsdale 17 : "The phenomena of erethism 

 which characterizes the first stage embraces, first, a painful 

 hypercesthesia, which manifests itself in headaches and rheu- 

 matic pains; second, an hypertrophy of the muscular fibers 

 which may give to patients a muscular power greater than 

 usual; third, palpitation of the heart accompanying the hyper- 

 trophy of that organ; and, finally, the polyphagia and polyuria 

 which may be considered to be connected with an erethic state 

 of the respective organs." Everything here points to over- 

 activity. But these are only the milder manifestations. Tam- 

 burini, for instance, describes a case in which "the mental 

 symptoms, on account of which the patient was sent to the 

 asylum, began to show themselves only a year before her ad- 

 mission. They consisted chiefly in delusions of suspicion ac- 

 companied by threats and acts of violence. The patient pre- 

 sented, in a marked degree, the bodily changes characteristic 

 of acromegaly. While in the asylum she was confused, resistive, 



16 De Cyon: Archives de Physiologic, July, 1898. 

 " Hinsdale: Loc. tit., p. 30. 



