514 THE POSTERIOR PITUITARY AND THE NERVOUS SYSTEM. 



peared, and ultimately the muscle weariness so gained upon 

 her that she had to take entirely to bed. . . . Sensory 

 disturbances are marked. Shooting pains in combination with 

 paraesthesia, tingling, and numbness are complained of in the 

 arms and legs. Neuralgic pains are felt also in various parts 

 of the body, viz.: the face, chest, back, and loins. A remark- 

 able perversion of thermic sensibility is found in the lower 

 limbs and over the front of the abdomen and chest up to about 

 the level of the fourth rib, the patient having no sensation 

 of heat in these regions. . . . Sternberg remarks particu- 

 larly on the occurrence of pain and parsesthesia as valuable 

 signs for diagnosis in the early stages of the disease; they are 

 probably due, he considers, to changes in the cutaneous nerves." 



In a previous chapter we said: "Whether the mental 

 symptoms are ascribable to the cerebral hyperaemia or to the 

 impairment of certain functions of the pituitary itself, or to 

 both, it is as yet impossible to say." It now seems evident 

 that loth organs are involved in the pathogenic process. If the 

 far-reaching meaning of this fact is freely grasped, it seems 

 clear that there lies hidden under the whole fabric of which 

 we only now see the outline a truth of overwhelming impor- 

 tance to we physicians: i.e., the fact that it is not only in 

 acromegaly that the typical signs of impaired function of the poste- 

 rior pituitary shows itself, but in all syndromes directly ascribaUe 

 to the suprarenal system: i.e., myxcedema, cretinism, exophthalmic 

 goiter, and Addison's disease, which include in their aggregate the 

 majority of organic changes of a morbid kind to which the system 

 is liable. 



This may be briefly illustrated by further quotations from 

 Dr. Pirie's excellent paper, entirely devoted to the one case. 

 As regards the muscular system, the author states that "mus- 

 cular atrophy is a prominent feature, affecting the thenar, 

 hypothenar, and interossei muscles of the hands, the forearm- 

 and arm- muscles, the calf- and thigh- muscles, and also the 

 glutei," and refers to Duchesnau, 20 "who has made a special 

 study of the atrophy of muscles in acromegaly. So marked is 

 it in some cases that it has been mistaken for syringomyelia, 



80 Duchesnau: These de Lyon, 1891. 



