$02 HAEVEY G. BECK 



is a frequent accompaniment of clinical conditions in which an insuffi- 

 ciency of the gland is manifest. Moreover, that the brain, under these cir- 

 cumstances^ is possibly overexcitable is suggested by the number of in- 

 dividuals in whom gustatory attacks have occurred under the influence 

 presumably of a direct local irritation of the adjacent uncinate cortex 

 by the enlarged gland. 



4. As is well known, epilepsy is a. frequent sequel of cranial injuries. 

 In certain types of injury, as the common bursting fractures of the base, 

 the pituitary body is prone to be damaged. 



5. If, as we believe to be the case, the posterior lobe secretion nor- 

 mally enters the cerebrospinal fluid and thus comes to be in solution in 

 a fluid which subsequently bathes the cortex, it is possible that its diminu- 

 tion from hypophyseal disease or injury may unfavorably affect the ac- 

 tivity of the cortical cells. On this basis it is conceivable that a local scar 

 which involves, or a tumor which presses upon, a given area of the cortex, 

 may prevent the access to the cells of a substance which is essential to 

 their functional stability. 



6. Many individuals, supposed to be suffering from so-called genuine 

 or essential epilepsy, present manifestations of a nutritional disorder 

 a tendency to adiposity and a high sugar tolerance, coupled with a lowered 

 temperature and pulse rate closely akin to the constitutional state which 

 characterizes hypophyseal deficiency. In some of these individuals the 

 administration of hypophyseal extract has served to moderate the seizures 

 from which they previously suffered." 



Johnston basing his opinion on the X-ray findings of the sella turcica 

 states that the factor chiefly concerned in a certain group of cases 

 of epilepsy is a mechanical one. The small roofed sella which encroaches 

 upon the gland interferes with the normal blood supply and physiological 

 activity, in consequence of which the animal economy is deprived of those 

 substances produced within the pituitary necessary to stimulate normal 

 metabolism. He substantiates his view by the fact that these cases are 

 benefited by pituitary feeding, and suggests that relief might follow the 

 resection of the clinoid processes; in other words, by a sellar decompres- 

 sion. Numerous other researches have been made along this line, the re- 

 sults of which are too vague and indefinite to enumerate. 



Etiolojjy 



A review of the earlier literature gives one the impression that the 

 chief etiological factor in dystrophia adiposogenitalis is either a tumor of 

 the hypophysis or in close proximity to it. Subsequent reports, however, 

 indicate that various <;ther factors are concerned in the etiology, and that 

 hypophyseal tumors play a minor role, especially in their relation to the 



