HYPOPHYSIAL DYSTROPHY 317 



center at the base of the brain, occasioning obesity. Erdheim was forced to 

 this conception by the observations that also tumors situated extrasellarly 

 can lead to obesity. Among those authors who refer the obesity directly to 

 the loss of function the hypophysis, there are some who refer the tumor to the 

 loss of function of the nervous lobe, others to that of the glandular. Espe- 

 cially B. Fischer is an adherent to the doctrine that it is due to the nervous 

 lobe. He states as a chief argument the fact that the genital disturbance 

 belongs to the early symptoms of acromegaly too. Here it is produced by 

 pressure on the nervous lobe. Also Gushing, who formerly in common with 

 Crowe and Romans, brought the obesity into relation with the glandular 

 hypophysis, now agrees with Goetsch and Jacobson as to the significance of 

 the posterior lobe. Finally, another much discussed question is as to whether 

 the obesity is produced directly by the alteration of function of the hypo- 

 physis or secondarily by the functional disturbance of the sexual glands. 

 Lately B. Aschner has again taken up Erdheim's hypophysis and has cham- 

 pioned an atrophic center at the base of the brain, the function of which is dis- 

 turbed by the pressure of the growing tumor. He bases his opinion on the 

 fact that in growing animals total extirpation of the hypophysis never leads 

 to a marked grade of obesity, nor to such distinctly pronounced genital 

 disturbances as in youthful human beings. The result of the operation 

 on tumors of the hypophysis in human beings, so far as concerns the les- 

 sening of the obesity and the improvement of the genital function, depends 

 on a release of pressure from the hypothalamic region. Aschner sees an 

 especially strong support for his opinion in the experiments, the results of 

 which were recently published, through which it was possible to produce 

 marked trophic disturbance of the sexual glands through injury to the hypo- 

 thalamic region. To this view, E. Mutter has already opposed the fact that 

 trophic disturbances in processes at the base of the skull must be ascribed to 

 the compression of the hypophysis, as dystrophy and sexual glandular 

 disturbances are absent in brain tumors unattended with hydrocephalus 

 that have not involved the hypophysis. Also Marinesco and Goldstein 

 incline to this opinion, v. Noorden regards the obesity as thyrogenic (through 

 secondary influencing of the function of the thyroid gland). Finally, here, 

 as in acromegaly, the attempt has been made to place in the foreground 

 a primary disturbance of the sexual glands (Schuller, Tandler and Grosz). 

 Novak, on the other hand, influenced by the fact that operation may bring 

 about an improvement of the genital function without essential effect on 

 the obesity, is of the opinion that the obesity is independent of the genital 

 disturbance. We see almost "quot capita, tot sententiae." 



I shall first describe the genital disturbance, as I am of the opinion that 

 the obesity is given its characteristic expression through the genital disturb- 

 ance. It must here again be mentioned that the genital disturbance in hypo- 

 physiardystrophy is throughout not identical with that of acromegaly, as 



