PATHOLOGICAL ANATOMY AND HISTOLOGY 779 

 Changes in the Hypophysis in Infectious Diseases 



The anterior lobe of the hypophysis is a functionating gland. It 

 would not be surprising, therefore, to find that it is affected by the same 

 types of parenchymatous degeneration in acute infectious diseases associ- 

 ated with high temperatures, as are found in other glands of the body, 

 such as the liver and kidneys. However, I have not found in the literature 

 any reference to cloudy swelling of the hypophysis. This may be due to 

 the difficulties encountered in making any kind of gross anatomic diagnosis 

 of lesions of the hypophysis. 



Creutzfeldt and Koch, and Boehncke and Koch found the pars inter- 

 media greatly changed in 7 out of 9 patients dead of diphtheria. These 

 included deaths from general intoxication with diphtheria toxin and from 

 sudden cardiac paralysis. The changes consisted in margination of the 

 chromatin, pyknosis, karyorrhexis, and karyolysis, i. e., necrosis, of the 

 cells of the middle lobe. They produced similar changes in the hypophyses 

 of guinea pigs by the injection of pure cultures of diphtheria bacilli. The 

 injury to the pars intermedia was greatest in chronic poisoning of the 

 animals. These authors advanced the conception that these lesions of the 

 middle lobe are an important factor in those cases of diphtheria in which 

 the circulation fails before there is clinical evidence of changes in the 

 heart itself. At autopsy they found the lesions in the heart insufficient to 

 account for the severe atony of the vascular system. This conception may 

 well be questioned without more definite evidence. Schmorl observed 

 areas of necrosis in the hypophysis in diphtheria, without specifying their 

 location. Abramow has also studied the changes in the hypophysis pro- 

 duced in guinea pigs in experimental infection of these animals with 

 diphtheria. He does not mention necrosis of the cells of the pars inter- 

 media; but found quite constantly hyperemia, diminution of eosinophil 

 cells, and the appearance of cells with non-staining cytoplasm. In the 

 second week of the intoxication, these latter cells had greatly increased in 

 numbers and the eosinophils had almost entirely disappeared. Abramow 

 considered these elements to be eosinophilic cells that have become ex- 

 hausted as a result of excessive activity. 



Pirone(a) (c) has studied the histologic alterations in the hypophyses 

 of 8 human subjects, 7 dogs, and 30 rabbits, dead of hydrophobia. He 

 found in the posterior lobe lymphocytic infiltrations, usually perivascular, 

 but sometimes diffuse, and occasionally nodular, in distribution. These 

 resembled somewhat the changes commonly found in the Gasserian 

 ganglion in hydrophobia. There was also present hyperemia of the an- 

 terior lobe with slight "degenerative changes" in the epithelial cells. 

 These alterations were more pronounced in the protracted cases than in 

 those that were more 'rapidly fatal. Pirone(fc) also found that the by- 



