DYSTROPHIA ADIPOSOGENITALIS 861 



mensions, especially in the transverse diameter. The autopsy showed a 

 very large degenerated pituitary gland, an enormous deposit of subcu- 

 taneous fat Avith an increase of fatty tissue in the heart, liver and mes- 

 entery. 



Ocular symptoms were recognized long before obesity as a feature 

 of pituitary disease. Thus Vieussens as early as 1705 reported a case 

 of tumor of the hypophysis with amaurosis, and Ward (1823) and Hed- 

 lund (1833) each reported a case of tumor with total blindness. Harvey 

 (1855) mentions a sudden and complete amaurosis as the result of a 

 pituitary abscess and a scrofulous tumor compressing the optic nerve. 

 Optic neuritis and bilateral abducent 'paralysis occurred in a case of 



Leber's (1866) with gliosarcoma of the infundibulum and tuber cine- 

 reum. 



Numerous cases of pituitary disease were described before Mohr's 

 report; none of them, however, correspond as closely to Frohlich's syn- 

 drome. These reports deal more especially with the pathological 

 anatomy, although as a composite practically all the important clinical 

 manifestations are embraced which comprise the symptomatology of 

 dystrophia adiposogenitalis. A comprehensive review of the subject of 

 pituitary lesions was published by Rayer in 1823; in addition he cited 

 four cases and reported one of his own. He called attention to the fact 

 that Wepfer (1734) had observed a change in the size of the gland, and 

 Petit (1718) found the gland "squirrheuse" in most individuals with 

 hydrocephalus. Morgagni (1766) mentions a case in which the gland 

 showed a light yellow tint and others containing considerable mucoid ma- 

 terial. Glands containing concretions were reported by Vicq-d'Azyr 

 (1779) and Bichat. The latter also mentions a scirrhous condition and 

 suppuration. Among others Rayer quotes Chaussier (1812), who reported 

 enlargement of the pituitary, and Baillie (1815) and Rullier (1823) and 

 others who mentioned amaurosis as a symptom of pituitary tumors. His 

 personal observation (1814) was that of a man 47 years of age, who 

 gradually became lazy and careless, and developed mental retardation, 

 frontal headaches, failing vision terminating in total blindness, constipa- 

 tion, vomiting, stupor and slow pulse, Rayer in portraying the mental 

 condition of this patient gives a classical description of narcolepsy, a symp- 

 tom occurring in advanced hypopituitarism. At autopsy a pituitary tumor 

 was found an inch and a half in diameter. The adipose tissue, although 

 not abundant, was described as being very yellow and resistant, and the 

 omentum contained very yellow and solid fat. 



The case reported by Ward (1823), previously mentioned was some- 

 what similar. The patient was a man 38 years old, who had a large pitu- 

 itary tumor pressing on the optic and olfactory nerves causing blindness, 

 headache and a condition of stupor and somnolence of the same type above 

 mentioned. 



