HYPOPHYSIAL DYSTROPHY 315 



ively. In the cases that he observed only clinically there was probably sec- 

 ondary ventricular hydrops after brain tumors. 



Marinesco and Goldstein described two cases of hydrocephalus with genital 

 hypoplasia and obesity (no autopsy). Like the case of E. Mutter, the patients 

 were small of stature. Neurath further reports cases of hydrocephalus with 

 obesity in children. The genital disturbance was not always distinct. We 

 have to consider however that in children the genital disturbance would not 

 be so prominent as in adolescents. In a review of the pertinent literature 

 I have received the impression that in the slight grades of hypophysial 

 insufficiency the first sign is the development of an obesity. 



Also case 2 and case 3 of Babonneix and Paisseau belong to the group 

 just mentioned. In case 2 as in case i of Neurath the hydrocephalus de- 

 veloped after scarlet fever. 



Pathogenesis. The views as to the pathogenesis of the clinical picture 

 described , or as to the r61e that the hypophysis plays in it, deviate from one 

 another markedly. Even although at the present we are not in the position 

 to clarify satisfactorily all the manifestations belonging to this picture, I 

 still believe that the later results of pathological physiology and the evident 

 analogies with those diseases of the thyroid that are well-known have fur- 

 nished us with a valuable criterion. Let us first consider the results of the 

 pathological physiology. The difficult accessibility of the organ and its 

 immediate vicinity to centers important for life have made extraordinarily 

 difficult the experimental studies of the symptoms dependent on loss of the 

 hypophysial apparatus. Only recent years have brought comparative clear- 

 ness to the solution of the problem. In stating the experiments and their 

 results I shall confine myself to the most important. Paulesco was the first to 

 succeed in the complete extirpation of the whole hypophysial apparatus. 

 He and Gushing used the method of trepanation and pushing aside the 

 cerebral hemispheres. Both authors came to the result that the complete 

 extirpation of the entire hypophysial apparatus in dogs leads to death under 

 fall of temperature and blood-pressure, slowing of the pulse, increasing 

 apathy, and deep coma, and they inferred that the hypophysis is an organ 

 important for life, of which the anterior lobe is the part important for life; 

 this because complete extirpation of this alone led to all the manifestations 

 described. According to Gushing total extirpation of the posterior lobe 

 in several cases called forth convulsions and sexual overexcitement, but 

 mostly was without especial action. On the contrary B. Aschner on the basis 

 of his very beautiful experiments upheld the opinion that the lethal result 

 described depends on an injury to the tuber cinereum. Aschner used the 

 buccal method and found lethal coma on injury to the tuber cinereum and 

 opening of the third ventricle. Less severe injuries or wound infection brings 

 about the appearance of the so-called hypophysoprivic cachexia (marked 

 fall of temperature, apathy, anorexia, polyuria, eventually glycosuria, also 



