HYPOPHYSIAL DYSTROPHY 321 



has upheld the opinion that the obesity and the genital disturbances are due to 

 the involvement of the nervous lobe; Gushing has agreed with him and would 

 ascribe to the glandular lobe only the growth disturbance. Fischer regards 

 as the principal support of his argument the similarity of the kind of genital 

 disturbance in acromegaly and hypophysial dystrophy. I need hardly again 

 mention that this is not correct. A further support for the view is found in 

 the known tonic actions of the extracts of the posterior lobe on the genitalia, 

 and further the circumstance that in certain typical cases of hypophysial dys- 

 trophy, especially in squamous epithelial carcinoma, the sellar introitus is very 

 much distended and the nervous lobe is found to be destroyed, while the 

 glandular part is well retained (for example, case 2 of Bregman and Steinhaus), 

 although we find a very much larger number of cases in which the glandular 

 hypophysis has been destroyed by cyst formation, gummas, etc., while the 

 nervous lobe was found to be intact. The known tonic action of the extracts 

 of the posterior lobe applies only, as before mentioned, to the nerves of the 

 uterus, and on the contrary an activating influence on the sexual glands is not 

 at all known. Against a direct connection of a disturbance of the function of 

 the posterior lobe with the genital disturbance speaks, however, the following: 

 It is very probable that the polyurias of longer or shorter duration that occur 

 so frequently depend on an irritation of the posterior lobe. Now such poly- 

 urias of long duration are found also in cases with pronounced genital disturb- 

 ance. If, therefore, we refer the polyuria to a hyperfunction and the genital 

 disturbance to a falling away of the function of the posterior lobe, we would 

 not expect to find them both occurring together. In addition polyuria is 

 found eventually in acromegaly, also in cases with increased function of the 

 genitalia, or at least with failure of a functional disturbance of the interstitial 

 glands, hence it is quite independent of the nature of the genital disturbance. 



I must consider the question of polyuria somewhat more intimately. 

 Let us remember that transitory or more permanent polyurias, that eventu- 

 ally may show the entire disease picture of diabetes insipidus, are found very 

 frequently in the most diverse hypophysial diseases without acromegaly, 

 and indeed sometimes in acromegaly, and that the same thing is observed 

 also in tumors and other diseases of the brain-stem. Very important facts 

 for the origin of these polyurias are furnished by experimental pathology. 

 As has been previously presented, there may be obtained from the nervous 

 lobe of the hypophysis an albumin-free heat-stabile extract that possesses 

 in addition to its known action on the blood-pressure, exquisite diuretic 

 characteristics. Schafer states further that the polyuria occurs in the different 

 classes of animals also after feeding with the posterior lobe. Furthermore, 

 implantation of the hypophysis causes an increase of the amount of urine 

 (Crowe, Gushing and Romans} that again disappears after extirpation of the 

 transplant. Under circumstances the polyuria lasts for several days. 



Furthermore, polyuria that may last for many days is very frequent in 



