306 THE DISEASES OF THE HYPOPHYSIS 



The examination of the respiratory gas exchange (Dr. Bcnisetiit) shows: 



CO" elimination 5.14 1 ... 



> Average of three well-concurring observations. 

 O2 consumption o.n J 



The temperature is instituted at a low level, ordinarily between 36 and 36.4. 



Injection of 4 cc. pituitrinum glandulare intramuscularly shows slight increase of 

 temperature, up to 37. 



Nov. 6. Injection of 5 cc. pituitrinum glandulare intramuscularly at 9 A.M. causes an 

 afternoon rise of temperature to 38.5 (4 o'clock). At 8 o'clock still 38. On the next 

 morning temperature again 36.2, no subjective manifestations. 



The investigation of the gaseous exchange after the injection shows a very marked 

 decrease of the carbonic acid production and the oxygen consumption. There was appre- 

 ciable increase of respiratory quotient. 



Repetition of the experiment on Nov. 13 with 5 cc. of pituitrinum glandulare (intra- 

 muscularly) brought about an increase of temperature to over 38C. 



The amount of urine varied between 2000 and 4000 cc. Correspondingly the specific 

 gravities varied between 1010 and 1006, exceeding 1010 very rarely. 



At the beginning several bowel movements daily, later only one or two. The stools are 

 mostly more or less brothy, whitish, glistening like fat, containing, as is shown on micro- 

 scopical examination, many needles of soap fatty acids and of neutral fat. 



Appetite and general condition improve rapidly, also a rapid increase of body weight 

 from 24 kg. to 32^ kg. in the course of five weeks, with distinct prominence of the abnor- 

 mal distribution of fat on the buttocks, mons Veneris, etc. 



The intelligence of the boy is in general well developed, temperament is gay. The 

 complaints as to headache are less. 



X-ray examination of the hand shows marked developmental disturbance of ossifica- 

 tion. The development of the bone-nuclei about corresponds with that of an eight- to 

 nine-year-old boy. 



In this case we are dealing with a chronic hydrocephalus that apparently 

 has led since earliest youth to disturbance of the function of the hypophysis 

 through pressure on the entrance to the sellae. For the disturbance of hypo- 

 physial function speak: i. The growth disturbance and the disturbance in 

 ossification and dentition. 2. The genital dystrophy with the typical obesity. 

 3. Perhaps the "thermoreaction." Whether there exists here a disturb- 

 ance in metabolism we cannot decide, as there are no values of comparison 

 with normal individuals of the corresponding size and weight. Fitting in 

 with the diagnosis are also the behavior of the carbohydrate metabolism, 

 the blood-count, the hypothemia, and the slight degree of polyuria. 



There are as yet no statements in the literature as to the proportioning 

 of the skeleton and the ossification conditions. In the study of my cases I 

 made certain observations that seem to me important for the differential 

 diagnosis of the hypophysial dystrophy from the primary genital dystrophy. 



The proportioning is sometimes more of an infantile, sometimes more of a 

 eunuchoid type, that is, in the latter case the lower length considerably ex- 

 ceeds the upper length. In a case of Ettore-Levi the total length was 130 cm., 

 the lower length 71 cm. In my case L, Observation XXXIII, the total 

 length was 131 cm., the distance from the anterior superior spine to the in- 



