HYPOPHYSIAL DYSTROPHY 323 



to the hypophysis in this respect it seems to be worth while to approach the 

 question by asking whether there exist any essential differences between the 

 polyurias of idiopathic and of symptomatic diabetes insipidus. Forschbach 

 and Weber assume that in idiopathic diabetes insipidus the kidneys are 

 especially sensitive and irritable, so that they react to a diet rich in gram 

 molecules [molenreich] with more marked diuresis. Talquist and E. Meyer 

 formulate their opinion by the assumption that the kidneys are incapable 

 of concentrating the urine. Breuning believes, from a collection of the per- 

 tinent cases from the literature, that he is able to conclude that (also in symp- 

 tomatic diabetes insipidus) the kidneys have lost the capacity of concentra- 

 tion. Also Frank found it absent in his case. I must point out in opposition 

 to this that this dictum in a general sense does not hold for symptomatic 

 diabetes insipidus. I refer to Observation XXXVII, in which the specific 

 gravity of the urine, after several days of vomiting, rapidly rose to 1013. 

 Also the test in case K, Observation XXXVIII, showed, after increase of 

 salt to the diet, an increase in the elimination of salt, but during this day 

 the total amount of urine did not increase. I would here mention some ex- 

 periments that we carried \put on rabbits. In these injection of pituitrinum 

 infundibulare produces marked diuresis. When sodium chloride is adminis- 

 tered at the same time there occurred, in spite of diuresis, an appreciable 

 increase of the concentration of the urine. Hence it appears to me that we 

 must leave the question of the genesis of idiopathic diabetes insipidus open. 



For the comprehension of the diseases of the hypophysis, a careful con- 

 sideration of the relations between the hypophysis and the thyroid gland seems 

 indispensable, so that I shall here enter into a more intimate discussion of 

 these relations. First some experimental facts. After extirpation of the 

 thyroid gland in young animals there has been observed an enlargement of 

 the hypophysis (Gley and others). The enlargement affects the glandular 

 part. Vacuoles are found in the cells. Conversely, an enlargement of the 

 thyroid gland occurs after extirpation of a part of the adenoma in acromegaly. 

 In myxedema the hypophysis has been found to be enlarged; sometimes, 

 not always. In such cases the enlargement may well depend on strumous 

 degeneration. On the other hand, Benda has stated that in Basedow's dis- 

 ease the glandular hypophysis is small. The statements as to the physio- 

 logical correlations between the two ductless glands evidently do not agree. 

 Of greater clinical interest seem to me the pathological correlations between 

 hypophysis and thyroid. 



I already have often referred to this question. Thus in endemic cretinism 

 we have seen that not the thyroid alone, but mostly also the hypophysis is 

 strumously degenerated. Josefson reports associated hyperplasia of the 

 hypophysis in a case of congenital struma of the thyroid gland. Also quite 

 other kinds of processes seem to occur spontaneously in the two ductless 

 glands. Thus Rosenhaupt reports a case of sarcoma of the anterior lobe of 



