326 THE DISEASES OF THE HYPOPHYSIS 



another a slight menstrual hemorrhage was observed some months after the 

 operation. The improvement in the blood picture after operation is notice- 

 able in Observation XXXIV. Also the mental condition changed, and the 

 patient was much more impressionable. Even the combating of the pres- 

 sure symptoms alone and the saving from complete blindness might in 

 themselves be regarded as a striking result; extreme care must always be 

 taken in considering the indications for or against operation. Apart from 

 the danger of the operation we should consider that the surgeon should not 

 remove just that part of the hypophysis that functionates, thereby increasing 

 the dystrophic manifestation and eventually bringing on a cachexia. The 

 operation is therefore only indicated in tormenting symptoms of brain pres- 

 sure or in rapid increase of the visual disturbance. The tumor tissue can- 

 not be radically removed by any of the methods named. Therefore no case 

 without relapse. 



The conception of dystrophia adiposo-genitalis as hypopituitarism leads 

 us to expect results from a therapy by administration of hypophysial sub- 

 stance. Levy and Rothschild, Axenfeldt and Delille, as well as Cushing, claim 

 to have seen good results. In one case I also saw a striking improvement. 

 Leman and van Wart after the administration of hypophysis tablets saw a 

 growth of hair on the torso. The tumor symptoms (hemianopsia, etc.) are 

 naturally not improved by this treatment. Thyroidin may be used with 

 effect against the obesity. In cases with marked tormenting symptoms of 

 cerebral pressure in which a radical operation is not possible or does not seem 

 advisable, palliative trephining or Anton's "Balkanstich" [puncture of the 

 corpus callosum] brings relief. Finally it should be mentioned that Beclere 

 saw improvement of the visual disturbance after X-ray irradiation. 



Therapeutic Use of Hypophysis Extracts. While in the treatment of hypo- 

 physial diseases even the use of preparations from the hypophyses of animals 

 has not as yet won general recognition, yet the extracts from the pars inter- 

 media or the posterior lobe of the hypophysis, pituitrinum (pituitrinum 

 infundibulare is a preferable designation) have rapidly acquired a place in 

 gynecology and obstetrics. The investigations of v. Frankl-Hochwart and 

 Frohlich have justified our using them in postpartum bleedings. Foges and 

 Hofstatter in Vienna and simultaneously Bell in England first reported the 

 favorable influence on hemorrhages after labor, in which the tendency of the 

 uterus to contraction was heightened by the preparation. The agent may be 

 used intramuscularly as well as intravenously (12 cc. in 20 cc. physiological 

 salt solution) (Hofbauer). In the numerous experiments of Foges and others, 

 it was found to be entirely harmless. The agent is especially valuable for 

 Cesarean section. Lately its use has been commended for hemorrhage from 

 the nongravid uterus . (Bab). It is also recommended in postoperative 

 paresis of the bladder (Hofstatter). The voluminous literature pertaining to 

 the subject is found in the works of J. Novak and of C. Heeke. Finally there 



