112 JOHN T. HALSEY 



certain cases of exophthalmic goiter is to be considered as due to organo- 

 therapeutie or hormonotherapeutic action. 



Dystrophia Adiposogenitalis and Pituitary Obesity. The treatment 

 of these conditions by administration of posterior pituitary gland will 

 be deferred to a later section, because of the uncertainty as to the role 

 played in them by the different portions of the gland, and because in 

 most of the cases treated by administration of pituitary substance prep- 

 arations of the whole gland have been used. 



Acromegaly. In the late stages of this disease, where hyperfunction 

 has been succeeded by hypofunction, the administration of posterior 

 pituitary substance can be of benefit if there be present symptoms of 

 hypofimction of the pars posterior. Ordinarily in such cases the use of 

 preparations of the whole gland would be preferable. 



Disturbances in the Functions of the Female Genital Organs. Pos- 

 terior pituitary therapy in this type of case is treated elsewhere. 



Diabetes Insipidus. Francisco, in 1913, appears to have been the 

 first to employ posterior pituitary extract successfully in the treatment of 

 this condition. His experience was promptly co<rroborated by numerous 

 observers, especially by Motzfeldt (a) (b) (c) (1917-1918), who has made 

 an extensive clinical and experimental study of this matter. At the 1920 

 meeting of the Society for the Study of the Internal Secretions, Barker 

 reported successes in a considerable number of cases. In the discussion 

 following this paper, Engelbach, Kowntree, and others, also reported 

 almost uniform success. 28 



In most of the cases benefit is obtained only by hypodermic or intra- 

 muscular injections, but Motzfeldt (1918) reports one case markedly 

 benefited during two years by the oral administration of from 2 to 1 fresh 

 ox glands per diem ; and Rowntree, in the discussion at New Orleans, re- 

 ported that in one mild case the oral administration of 4 ox glands per 

 diem controlled the polyuria fairly well, and that in another case the 

 extract administered rectally would hold it in check for 3 or 4 hours. It 

 has been the experience of the various observers that as a rule the injec- 

 tion of 1 c.cm. of the 10 per cent extract controls the polyuria for from 

 (5 to 10 hours. However, the effect varies within wide limits, as little as 1 

 c.cm. injected every fifth day having sufficed in one case (Rowntree), while 

 in others satisfactory relief could be obtained only by the injection 2 or 3 

 times daily of 1 c.cm. As the injections often cause considerable pain 

 and discomfort, it is wise in most cases to attempt to control only the 

 nocturnal polyiiria. In some patients the cathartic effects of the injec- 

 tions are extremely inconvenient. In such cases smaller dosage more 

 frequently administered may be tried. The effects obtained .are almost 



^Tn view of Abel's (1010) claim that histamin is one of the active principles of 

 this gland, Home interest attaches to Rowntree's report that this substance failed to 

 exert any influence in cases of diabetes insipidus in which it was tried. 



