784 J. P. SIMONDS 



diabetes mellitus." More rarely, the anterior lobe or even the whole 

 hypophysis may be replaced by mature connective tissue as in the cases 

 recorded l5y Konchetti, Fahr, Boyce and Beadles(&). V. Gierke(a) has 

 reported the case of a man, aged 23, who passed from 4 to 5 liters of urine 

 per day, and whose hypophysis, at autopsy, showed a normal anterior lobe 

 with the neurohypophysis densely infiltrated with lymphocytes and a 

 smaller number of eosin-staining cells. No tubercle bacilli were found and 

 there was no evidence of syphilis in the body. V. Gierke therefore con- 

 sidered the lesions as "some kind of chronic inflammation." 



Syphilis of the Hypophysis. In acquired syphilis lesions of the hy- 

 pophysis are rare and usually occur in the form of gammas. In the con- 

 genital form, there is usually a diffuse indurative process, and, more 

 rarely, gummatous areas. In 1,500 hypophyses studied by Simmonds(/) 

 syphilitic changes were observed 9 times. Schmorl mentions two gummas 

 of the hypophysis in acquired syphilis, a scar probably the result of a 

 healed gumma, an( l frequently diffuse proliferation of connective tissue 

 in syphilitic individuals, without giving further details.. Benda(c) also 

 mentions 3 gummas of the hypophysis observed by him. I have collected 

 from the literature records of 26 gummas of the hypophysis (Wagner, 

 Weigert(a), Barbacci, Birch-Hirschfeld, Hektoen, Troisier, Beadles, 

 Sokoloff, Hunter (a), Kufs(a), Stroebe, Poscharisky, Starck, Chiari, 

 Bianchi, Goldzieher, Simmonds(i), Fry, Woolley,. Berger and Schulmann, 

 and Verse, each one case; Schmorl, 2 cases; Benda(c), 3 cases; and Sim- 

 monds(^), 9 cases, without details). Two of the above 26 cases were in 

 congenital syphilis, the remainder in the acquired form. The above list 

 includes a case reported by Wagner as tuberculosis of the hypophysis, but 

 which has been classed by Heidekamp and others as a gumma. 



Uncertainty attaches to all of the cases of both tuberculosis and 

 gunnnas of the hypophysis reported before the discovery of the tubercle 

 bacillus. 



Gummas of the hypophysis are found in the anterior lobe more com- 

 monly than in the posterior. They are usually single but may be multiple, 

 as, for example, the case of Berge and Schulmann, in which 8 gummas 

 were found, most of them in the posterior lobe. Occasionally the entire 

 gland is affected as in the case of Hektoen. A hypophysis that is the 

 seat of a gnniniatons process is usually larger than normal, although the 

 actual weight has been recorded in very few cases. In the case reported 

 by Hektoen the gland weighed 1.8 grains. In other instances the size of 

 the hypophysis is described as that of a "cherry seed," or a "small nut," 

 or kk a walnut," or "a small marble, 7 ' or "a pigeon's egg." 



A gnniniatons hypophysis is usually adherent to the sella turcica, and 

 its capsule is thickened. The consistency is usually firmer than normal. 

 On surfaces made by sectioning the color is yellowish-white, or grayish- 

 yellow, or grayish. In some instances the central portions are definitely 



