THE GENERATIVE APPARATUS 379 



already emphasized in the article on ductless gland diseases in Mohr-Stae- 

 helins handbook (Vol. IV), I cannot subscribe to the opinion upheld 

 especially by Tandler and Grosz that during pregnancy the "internal secre- 

 tory" activity of the ovary is inhibited by the persistence of the corpus 

 luteum. By "internal secretory" activity is understood by these authors a 

 function that in fact can only depend on the interstitial glands. Against 

 an inhibition of the interstitial glands speaks, however, the fact that during 

 pregnancy the secondary sexual characters throughout do not retrogress, 

 and on the contrary there is found, in agreement with histological findings, 

 strong accentuation of them. Entirely especial, however, are the views 

 concerning the relation of the sexual glands to the hypophysis, which had 

 led to the rapid entrance into the literature of what I consider an incorrect 

 view. Therefore I must enter into this question more in detail. 



The hypophysis in woman during pregnancy enlarges considerably. 

 Its weight can rise to two and one-half times as much as normal. Enlarge- 

 ment of the anterior lobes is exclusively responsible for this increase in weight; 

 this lobe becomes more juicy and essentially softer. It shows the occurrence 

 of enormous numbers of pregnancy cells, which develop from the so-called 

 chief-cells. In the later stages of pregnancy more than four-fifths of the organ 

 may consist of the new formed cells. . Comte, and Launois and Moulon first 

 pointed out this enlargement of the hypophysis, and Erdheim and Stumme, 

 whose exposition I follow, carefully studied these alterations in a great num- 

 ber of cases. Then enlargement of the hypophysis during pregnancy is some- 

 times so considerable that in rare cases even a pressure-action on the chiasma 

 seems to be possible, v. Reuss described repeated temporary blindness dur- 

 ing pregnancy, while Bellinzona and Tritondani report bilateral narrow- 

 ing of the visual field. Actually there exist a series of manifestations that 

 point to an increase in function of the hypophysis during pregnancy. To 

 these may belong the osteophyte formations on the internal surface of the 

 skull that are associated with marked hyperemia of the dura. In addi- 

 tion they are found also on the upper jaw, on the nose, and on the frontal and 

 parietal bones (Manau), further the development of substance devoid of 

 calcium in the pelvis. Breus and Kolisko observed increase of the growth 

 of the pelvis during pregnancy. Tandler and Grosz point out that in gravid 

 persons there is a coarsening of the facial features, especially of the soft 

 parts of the nose, lips, and moreover that a thickening of the hands is not 

 rare, manifestations that remind pne of a slight grade of acromegaly. I 

 refer in the chapter on the hypophysis to the case of Marek, in which we 

 can indeed speak of a transitory forme fruste of acromegaly. As far as the 

 growth of hair on the linea alba is concerned, I should rather ascribe it to 

 the hyperplastic alterations of the suprarenal cortex. Into association with 

 increase of function of the hypophysis may be brought also the observa- 

 tion of Halban that in youthful persons whose epiphysial junctures are not 



