ACROMEGALY 853 



hyperactivity of the hypophysis by means of the X-ray is theoretically 

 sound, and recent technical advances have rendered this treatment practi- 

 cable. It was introduced by Gramegna in 1909. He gave two weekly 

 treatments, directing the rays to the sella turcica through the mouth 

 After eight treatments there was less headache and improvement in vision 

 but later the condition grew worse and renewed treatment was futile. On 

 account of the insufficient space between the teeth Beclere devised a spe- 

 cial method of passing the rays through the frontal and temporal region 



Fig. 22. Approach to hypophysis by infranasal method. (After Harvey Cushing, 

 J. Am. M. Assn., 1914.) 



which now is generally employed. The numerous reports of marked im- 

 provement of the visual fields as well as of subjective symptoms are en- 

 couraging and to a considerable extent convincing, allowing for the factors 

 mentioned in connection with the glandular treatment. Among the most 

 convincing and objective reports, in addition to Beclere's, are those of 

 Jaugeas(fr), Kiipferle and v. Szily, Schafer and Chotzcn, Cavazzeni, and 

 Webster. The treatment is more efficient after an operation on the sella 

 has been performed since much of the bony resistance to the rays then is 

 done away with. Radium is recommended together with the X-rays by 

 Kiipferle and v. Szily who also advise the internal administration of iodin 

 preparations during the treatment. 



Surgical Treatment. Here we are no longer dealing with mere theo- 



