PATHOLOGICAL ANATOMY AND HISTOLOGY 787 



with tuberculous meningitis, in my collected series of 10 cases, the pres- 

 ence of tuberculous meningitis is mentioned specifically in 7 instances. In 

 all of these cases there was also acute generalized miliary tuberculosis. 

 The main body of the hypophysis is rarely involved in those cases of 

 tuberculous meningitis not associated with generalized miliary tuber- 

 culosis. Simmonds 0'), however, found the infundibulum almost always 

 infected in tuberculous meningitis, the process being limited to a more 

 or less thick infiltration about the infundibulum and, somewhat less fre- 

 quently, an infiltration of the capsule of the gland. In 7 cases of tubercu- 

 lous meningitis not associated with general miliary infection, Hiiter 

 foun^ the hypophysis free, although in two of the cases there were miliary 

 tubercles in the capsule of the anterior lobe. The inf requency with which 

 the body of the hypophysis is involved in tuberculous meningitis is prob- 

 ably due to the protective action of the capsule and of the covering dura 

 mater ; to the very scant vascular connection between the meninges and the 

 hypophysis, this being limited to a very few minute vessels from the 

 leptomeninges to the infundibulum; and, possibly, to the absence of 

 lymphatics in the hypophysis, as asserted by Thaon (6). 



Tuberculosis of the hypophysis is practically never primary. In the 

 cases of Beck, Zenoni, and Gushing (a), only, was it specifically stated that 

 no tuberculosis was found elsewhere in the body. 



The two sexes were about equally affected in my collected series of 28 

 cases of tuberculosis of the hypophysis, notwithstanding Froboese's rather 

 startling statement that tuberculosis of the pituitary body "is seen only 

 in women." 



Tuberculosis of the hypophysis is only rarely associated with symptoms 

 referable to that gland, although in many of the recorded cases clinical 

 data are very imperfectly reported. The patients of Boyce and Beadles (6) 

 and of Beck were blind; in each instance the anterior lobe was affected 

 and much enlarged. Polyuria or diabetes insipidus is recorded in 4 cases. 

 Hiiter 's patient was a dwarf. Simmonds (I) believes that tuberculosis of 

 the hypophysis may be the cause of "hypophyseal cachexia." 



Simmonds (k) has recorded the case of an old woman in whose hypophy- 

 sis he found "true giant cells" adjacent to accumulations of round cells 

 and epithelioid cells. These nodules resembled tubercles, but, Simmonds 

 asserts, they have nothing to do with either tuberculosis or syphilis, and 

 are a "formation sui generis" 



Actinomycosis of the Hypophysis, Belkowski has reported a case of 

 actinomycosis of the base of the skull and meninges which began in the 

 sella turcica. 



