66 FIELDING H. GAKKISON 



Oliver and Schafer (a) found that the mammalian pituitary possesses an 

 active principle which, upon injection, elevates the blood pressure and in- 

 creases the force of the heart beat. In 1898, Professor William H. Howell, 

 of the Johns Hopkins University, showed that this property is possessed by 

 the extract of the posterior lobe (pars intermedia) alone. This extract (pit- 

 uitrin) has a specific action upon the smooth muscle of the uterus and bowel, 

 whence its use in obstetrics (uterine atony) and in postoperative intestinal 

 paresis. It is of distinct value in hypopituitary states. In his Harvey Lec- 

 ture of December 10, 1910, Gushing introduced the pathological idea of 

 "dyspituitarism," or perverted function of the gland, as a generic concept, 

 covering excess or insufficiency of its function, and for the following rea- 

 sons. In accordance with the clinical and pathological findings of Parry, 

 Graves, and Basedow, exophthalmic goiter was regarded as a state of "hy- 

 perthyroidism" or excessive secretion of the gland, while the myxedema of 

 Curling, Gull, and Ord was termed "hypothyroidism" (diminished secre- 

 tion or insufficiency). But it was found that in many cases the two condi- 

 tions may be blended, as Paracelsus had originally surmised in the Salzburg 

 region, producing an overlapping of the cardinal symptoms of either. For 

 this reason the term "dysthyroidism" was proposed by Marie for both. In 

 like manner, states of overactivity in the pituitary (hyperpituitarism), 

 associated with overactivity of the sexual glands, or of underactivity 

 (hypopituitarism), associated with genital aplasia and sexual inactivity, 

 may be superimposed one upon the other, making the term "dyspituitar- 

 ism" more appropriate in the majority of cases. As a goitrous mother may 

 have a cretinous infant, a big, bony acromegalic woman, as originally ob- 

 served by Crookshank and confirmed by Gushing, may have a son afflicted 

 with pituitary infantilism or obesity. Gushing (d) has also shown 

 that there is evidence of pituitary activity in pregnancy and hibernation 

 (1912), and his experiments upon its relationship to the sympathetic nerv- 

 ous system (1913) have led him to the conclusion that a lesion of the 

 posterior lobe (pars intermedia) may cause the increase of normal urine 

 (polyuria), otherwise known as diabetes insipidus. Finally, he has de- 

 vised a standard surgical procedure for approaching the almost inaccessi- 

 ble pituitary gland, which was first operated upon in man with success by 

 II. Schloffer in 1907. Physiological or Hunterian surgery, which had 

 almost fallen into abeyance until the twentieth century, has been the prin- 

 cipal means of elucidating the obscure physiology of the ductless glands. 



Tn this connection, it is interesting to note that the first experiment in 

 physiological surge ry upon human beings was performed by the gynecolo- 

 gist, Robert Battey, of Georgia, who, on August 27, 1872, excised the 

 normal ovaries for the relief of a neurotic condition. The physiological 

 basis of this operation, a supposed internal secretion from a specialized set 

 of interstitial ovarian cells, has been indicated in many ways. A Battey's 

 operation upon women who have not attained the menopause will produce 



