322 THE DISEASES OF THE HYPOPHYSIS 



operations on the hypophyses, as all later authors agree (Schafer. Pushing 

 and others). Schafer found a similar polyuria in nonbloody mechanical 

 or chemical irritation of the hypophysis. All these experiments seem to 

 indicate that increased production of this secretion through chronic condi- 

 tions of irritation (pressure, inflammation, etc.) can occasion a polyuria. 



On the other hand it is known that in the medulla oblongata and also 

 further up in the brain-stem, there are found loci, the irritation of which 

 may cause marked polyuria lasting for days. As is known, Bernard's piqure 

 is associated with polyuria. If, however, the puncture is done further up, 

 exclusively, polyuria results. 



Hence the conditions are such as the conditions with regard to the genital 

 disturbance. Extirpation of the hypophysis or destruction of a place in the 

 subthalmic region lying above the hypophysis leads to genital atrophy; irritation 

 of the posterior lobe or irritation of a definite place in the brain-stem leads to 

 polyuria. 



Hence one can readily conceive that in tumors or inflammatory processes 

 in the brain-stem or at the base [of the brain], a continuing condition of irri- 

 tation may be set up in these centers, and on account of it a transitory or 

 permanent polyuria. 



The following possibilities should be considered: These polyurias may 

 be always the result of a condition of irritation or of hyperfunction of the 

 pars intermedia or the posterior lobe, assuming that tumors proceeding 

 from the glandular hypophysis or from the peduncle, and other lesions, 

 irritate the posterior lobe for a longer or shorter time, and that disease 

 processes localized to the brain-stem also influence the hypophysis in like 

 manner; or all these polyurias may originate through irritation of the 

 nervous centers lying in the brain-stem; or, finally, it is possible that there 

 is a nervous connection between those centers and the nervous posterior lobe, 

 and that irritation of the former spurs on the latter to increased secretion. 

 The decision of this question is not as yet possible. However, it seems to 

 me very improbable that the exquisite diuretic action of infundibular ex- 

 tracts stands in direct relation with the polyurias of the tumors of the hypo- 

 physis. Also it seems very probable that in processes in the immediate 

 neighborhood of the hypophysial peduncle, the same series of actions is in 

 play; naturally we must acknowledge the possibility that such polyurias may 

 come about through stimulation of centers in the brain-stem, without media- 

 tion of the hypophysis. 



Finally we must consider the questions as to whether there are any 

 grounds for the fact that also idiopathic diabetes insipidus may be referred to 

 an increase of function of the pars intermedia. The question has been re- 

 cently discussed by Frank, among others. As up to the present there are no 

 pathologico-anatomical findings corresponding to diabetes insipidus and we 

 must also not neglect to mention that not enough attention has been directed 



