310 TIIF. DISEASES OF THE HYPOPHYSIS 



terior malleolus 69 cm.; also in case Si, Observation XXXIV, the lower length 

 is not essentially greater than the upper length. Quite infantile are the 

 dimensions in case Fr, Observation XLIV. On the contrary in case Sch, 

 Observation XXXVII, the lower length again distinctly exceeds the upper 

 length, as it does also in case P, Observation XLIII. It seems to me that 

 here two factors are working in opposite directions. The one is a genital 

 disturbance, which brings about tallness and excess of the lower length 

 over the upper length, the other is a growth disturbance conditioned by the 

 falling out of hypophysial function. According as the one or the other 

 predominates do the proportions approach the eunuchoid or the infantile 

 type. In the severest cases it is indeed mostly infantile. 1 



A distinct difference exists in the ossification conditions of hypophysial 

 dystrophy and eunuchoidism. As we shall see later, in the latter only the 

 epiphysial closure is disturbed; the development of the bone nuclei, however, 

 according to what has been observed up to the present, is not essentially 

 delayed. But the delay in the epiphysial closure is, however, of a high grade 

 and lasts until late life. 



How are the conditions in hypophysial dystrophy? Case W. (Observa- 

 tion XXXIX) reported by v. Frankl-Hochwart and v. Eiselsberg, was, when I 

 examined him, twenty-seven and one-half years old. The first symptoms had 

 set in at nineteen years of age; the condition of ossification was entirely 

 normal. In an eunuchoidism that had set in so late certain epiphysial junc- 

 tures would have remained open, and there would have been an additional 

 growth of some centimeters. In case L. (Observation XXXIII) and in 

 case Si (Observation XXXIV) the behavior of ossification approached the 

 normal. 



Quite otherwise are the relations in the cases in which the severe dis- 

 turbance of growth sets in early. In Case F. (Observation XLII) the 

 development of the bone nuclei corresponded to that of an eight- to nine- 

 year-old boy rather than to that of a fifteen-year-old boy. I refer to the 

 X-ray picture of this case as compared with that of a normal fifteen-year-old 

 boy (Figs. 61 and 62). 



Hence in these cases the growth disturbance is similar to that in hypo- 

 thyroidism. From the literature I can quote only the case of Bournier, 

 which shows that in the high degrees of growth disturbance also the closure 

 of certain epiphyses is markedly delayed. In the twenty-six-year-old patient 

 the proximal epiphyses of the phalanges and of the first metacarpal bones, 

 and the distal epiphyses of the ulna and radius, are still open. Finally the 

 case reported by Sprinzel in which ossification has remained behind much 

 farther than in my case F. 



From all this seems to be inferred, that the disturbance of ossification in 

 light grades of hypophysial dystrophy is not very pronounced, in severer grades 



1 1 refer to Chapters X and XII. 



