332 THE DISEASES OF THE EPIPHYSIS 



difference in the tumors may be explained by the fact that they represent the failure or 

 insufficiency [of function] of the epiphysis. We should therefore understand that nor- 

 mally in childhood inhibitory influences on development proceed from the pineal gland, 

 which gradually fall away or become slighter with the partial involution. 



This view has been especially developed by Marburg. Marburg believed 

 that hypopinealism leads to premature development of the genitalia, hyper- 

 pinealism to universal obesity and apinealism to cachexia. The interpre- 

 tation of adiposity as hyperpinealism is no longer held to be correct, even 

 by Marburg. It may very well come about through disturbance of the hypo- 

 physial function; one may see very well that the pineal gland tumors may 

 behave in this respect just like other processes that increase cerebral pressure, 

 the more so because on account of their position they lead to stagnation in 

 and dilatation of the third ventricle. The interpretation of the premature 

 development as hypopinealism has recently been supported by animal ex- 

 perimentation. Exner and Boese could not indeed observe a premature 

 development after extirpation of the epiphysis in young animals. C. Fod, 

 however, saw after extirpation of the epiphysis in young fowls a premature 

 and extraordinary development of the testicles and some of the secondary 

 sexual characters. Extirpation of the sexual glands in youth produces in 

 male and female animals atrophy of the epiphysis (Black and Hulles). 

 Askanazy believes that every embryonal teratoma is to be regarded as a 

 sort of pseudopregnancy that should lead to a premature maturation and a 

 premature development of the genital sphere, a view that Hart accepts, while 

 Pappenheimer opposes it. I do not regard it as impossible that the trophic 

 influences of the pineal glandular tumors in early life go over the suprarenal 

 cortical system, [hyperplastic development of] which also leads to premature 

 maturation and premature development of the genitals (see the following 

 chapter) . 



At least it should be noticed that in one case Raymond and Claude found 

 hyperplasia of the suprarenal cortex. I will quote this interesting case in 

 greater detail. It was that of a ten-year-old boy. The disease began in the 

 seventh year of life with gradual blindness and increasing adiposity. The boy 

 at the age of ten years was 138 cm. tall (about corresponding to a thirteen- 

 year-old boy) and weighed 39 kg. Much fat had accumulated, especially on 

 the abdomen and on the hips. The pubic hairs were well developed and there 

 was a foreshadowing of a beard on the upper lip. Penis and testicles were 

 small. Histologically the testicles showed no spermatogenesis, but the inter- 

 stitial glands were very well developed. The less strong predominance of 

 the premature genital development could in this case have been brought 

 about through a restriction in the function of the hypophysis; for the epiphy- 

 sial tumor, which was the size of an apple, had led to a marked dilatation 

 of the lateral and the third ventricles and to a marked flattening of the 

 hypophysis. 



