DYSTROPHIA ADIPOSOGENITALIS 901 



by excitation of the tuber cinereum and infundibulum. This view is sup- 

 ported clinically by a case in which at autopsy the hypophysis was normal, 

 but a tumor of the third ventricle was found. 



It has also been shown experimentally, that if the whole gland or a 

 very large portion of it be removed, profound somnolence is apt to develop. 

 This is associated with a subnormal temperature, slowing of the pulse 

 and respiration, and diminished sensitiveness to pain, symptoms which 

 frequently improve on the administration of pituitary gland substance. 



Somnolence has a tendency to occur periodically, sometimes daily aside 

 from the habitual sleeping hours, and then again with days intervening 

 during which they respond fairly normal, and the sensorium is reason- 

 ably clear. It is this condition which suggested the possible relationship 

 between the function of the hypophysis and hibernation in animals as 

 first pointed out by Gemelli (1906) and later emphasized by Cushing(6). 

 Persistent yawning, which often accompanies drowsiness, is a characteris- 

 tic feature. The entire syndrome of somnolence, yawning, dullness, 

 apathy, etc. with the presence of a clear sensorium shows a striking 

 analogy to that of encephalitic lethargica. The fluctuating character of 

 the former and the mode of onset are the chief differentiating fea- 

 tures. 



Epilepsy. Attention has been called by Gushing to the relation of 

 epileptiform seizures to lesions producing hypopituitarism. The so- 

 called unci.nate attacks are caused by a lesion extending into the inter- 

 peduncular region, producing pressure on or irritation of the uncinate 

 gyrus. The aura is characterized by hallucinations of taste and smell. 

 Sometimes the gustatory and olfactory phenomena with temporary loss 

 of memory constitute the attack; at other times the attacks are more 

 complete with marked convulsive seizures. General epileptiform seizures, 

 which occur without uncinate factors, are probably due to glandular in- 

 sufficiency, the result of hypoplasia. 



On the relation of epilepsy to pituitary disorders the following is 

 quoted from Cushing(&). "One may reassemble the data in regard to the 

 possible relation of hypophyseal insufficiency to epilepsy as follows: 



"1. Horsley, it will be recalled, in his first experimental hypophysec- 

 tomies in the canine, observed no postoperative changes whatsoever in the 

 condition of the animals. They were, however, used subsequently as sub- 

 jects of cortical stimulation, and he noted that the motor cortex was un- 

 usually excitable. 



"2. As already stated, we have observed a tendency to epileptiform 

 convulsions in a number of our animals kept for long periods after partial 

 hypophysectomy animals that ultimately exhibited symptoms which we 

 attribute to glandular insufficiency. 



3. The study of a series of cases of hypophyseal disease in man has 

 shown that epilepsy a symptom unobserved in states of hyperpituitarism 



