HYPOPHYSIAL DYSTROPHY 289 



The patient was operated on Nov. 29, 1911, by Dr. O. Hirsch at the Urbantschitsch 

 clinic, under local anesthesia. The septum was subjected to a submucous resection, 

 both sphenoidal sinuses were opened, the floor of the sella was chiseled off, and the tumor 

 partially curetted out, and partially removed through suction through a glass tube. The 

 total mass together with the blood, measured about 45-50 cc. There was no fever for the 

 first two days after the operation, then on the third day the temperature suddenly rose 

 to 39.5. Vomiting that lasted for five days. There was probably a hematoma in the 

 dural sac of the hypophysis, that went over into suppuration, was in part absorbed, 

 and in part flowed off (Hirsch); for several days the fever was very high, 39-40.5. The 

 third and fourth weeks it gradually declined. At the end of the fourth week the patient 

 was retransferred to the first medical clinic. The patient now makes an entirely different 

 impression, she is incomparably more lively, is interested in the surroundings and promptly 

 answers all questions. The falling out of hair has lessened. The thirst still exists. She 

 yawns much less, the hairiness of the axillae and of the mons Veneris has increased, the 

 visual power of O. D. has risen from i/io to 1.67/10. The headache disappeared entirely 

 after the operation, but reappeared again four weeks afterward. Very noteworthy are the 

 blood-findings. The differential count now shows: 



Neutrophiles 71 per cent. 



Lymphocytes, 25 per cent. 



Eosinophiles, i per cent. 



Mononuclears, 2 per cent. 



Transitional forms, i per cent. 



There is now distinct reduction on the ingestion of 100 gm. of dextrose. 



The patient has lost about 6 kg. > 



In typical dystrophia adiposo-genitalis is found, in addition to the 

 fattening, an inhibition of the development of the genitalia and of the secondary 

 sexual characters; in male individuals the penis remains quite small and 

 may even be entirely buried in the fat cushions (see Observation Sch, 

 XXXVII), the scrotum also remains small, the testicles remain quite 

 diminutive and are usually entirely undescended or partially descended on 

 one or on both sides. Also the prostate remains abnormally small. In 

 female individuals the external and internal genitalia remain quite infantile ; 

 the labia minora are developed but very poorly, the clitoris is short, the uterus 

 infantile, the ovaries may be not palpable, the breasts as a rule are indeed 

 very rich in fat, but are poor in glandular substances (see Observation 

 XXXIV). The nipples are small and retracted. Moreover there is either 

 no hairiness of the axillae, the pubic region, and the perineum, or in the pubic 

 region there are only a few bristly hairs. Men remain beardless. The voice 

 does not change or changes very incompletely. The vita sexualis does not 

 develop, and menstruation and ovulation do not occur. In certain cases in 

 which the disease has developed after puberty, there have been reports as 

 to subsequent falling out of the beard hair and the pubic hair, in men im- 

 potence sets in, and there is a cessation of erection and ejaculation; in 

 women there is a cessation of menstruation. Libido disappears in both the 

 sexes. There may also occur a partial retrogression of an accessory genital 

 apparatus that once was fully developed (see Observation G, XLV). 

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