330 THE DISEASES OF THE EPIPHYSIS 



Pathological Anatomy. The diseases of the epiphysis known up to the 

 present time consist chiefly in cyst formations, gummata, and tumors. 

 Neumann has collected twenty tumors from the literature and adds two of his 

 own; they were sarcomata, carcinomata, teratomata, gliomata, psammomata, 

 and cysts. The individuals affected were chiefly youthful so that, as Neumann 

 supposes, the underlying factors might well be chiefly developmental an- 

 omalies; these are very much more frequent in the male sex. The terato- 

 mata contain hair follicles, sebaceous glands, cartilage, fat, smooth muscle 

 fibers, etc. (Weigert and others). 



Symptomatology/ The symptoms that are produced by these lesions 

 of the epiphysis are on the one hand local symptoms, on the other hand char- 

 acteristic trophic disturbances. The first are caused by the pressure of the 

 enlarged organ on the neighboring brain structures (thalamic and subthala- 

 mic regions, pulvinar, pons, cerebellum, corpus callosum, etc.), and through 

 congestion in the brain ventricle. If the tumor grows backward, congestion 

 in the fourth ventricle occurs on account of closure of the aqueduct of 

 Sylvius; if it grows forward, there occurs hydrocephalus of the third and 

 lateral ventricles. The pressure symptoms consist in motor symptoms of 

 irritation or paralysis, ophthalmoplegias, conjugate deviation, alteration of 

 the pupillary reactions, nystagmus, ataxia, epileptiform convulsions (mostly 

 bilateral) , pareses, rigidity of the neck, choked disc, or more rarely genuine 

 atrophy, difficulty in hearing, vertigo, headaches, vomiting and eventually 

 slowing of the pulse, lethargy, symptoms that are common also to all the 

 tumors of the quadrigemina. 



In addition to these symptoms there occur, if the tumor develops in early 

 childhood, characteristic trophic disturbances that consist in an abnormally 

 rapid bodily development and in a premature development of the genitalia, 

 and are uncommonly similar to those which we shall consider under adeno- 

 mata of the suprarenal cortex. To this group belong the cases of Ostreich- 

 Slavyk, Ogle, Marburg, v. Frankl-Hochwart, and Raymond and Claude. 

 Throughout the cases were those of children under ten years of age. 



In the case of Ogle, the premature development of the genitalia was very 

 considerable. It was the case of a six-year-old boy who died with the mani- 

 festations of a brain tumor. Lately the boy had masturbated. The penis 

 was developed h'ke that of a seventeen-year-old youth. There was an abun- 

 dance of hair on the mons veneris. The testicles were apparently not en- 

 larged. Autopsy showed an alveolar sarcoma of the pineal body. The case 

 of Ostreich-Slavyk was that of a four-year-old boy who from the third year of 

 life had shown a striking body development; the penis was 9 cm. long, the 

 genitals were covered with hair i cm. long. The boy was 108 cm. tall and 

 weighed 20 kg.; these measurements correspond with those of a seven- to 

 eight-year-old boy. The mammae were hypertrophic and contained colos- 

 trum. At the beginning also voracious hunger existed, but later this 



