42 SMITH ELY JELLIFFE 



developed normally to the age of ten. He had not progressed much 

 beyond thfct, and at practically 17 years of age was only 12, psycho- 

 logically. The case was not one of Frohlich infantilism, nor a gonadal 

 infantilism. The subject was more of the hypothyroid type but showed 

 no cretinoid nor marked myxedematous manifestations. The thyroid 

 was apparently normal as was also the hypophysis. There was, how- 

 ever, marked hypoplasia of the testes and complete absence of the pineal. 

 There was marked anemia. There was no marked intelligence defect, 



Here then is a distinct contradiction of the Pellizzi hypothesis, and 

 of the Marburg concept. If the pineal has a gonadal inhibitory effect, 

 hypopinealism is supposed to result in gonadal precocity. Here, however, 

 no such overcompensatory relationship is established. The Pellizzi-Mar- 

 burg hypothesis has been reared chiefly on the basis (1) that tumor 

 formation has resulted in hypopinealism and hence over-compensatory 

 genital activity, and (2) conjectures concerning early involution of the 

 pineal functions. 



As will be here developed, this involution probably does not occur, 

 and the pineal possibly has a group of other functions which must be 

 investigated. The criteria adopted by earlier writers concerning involu- 

 tion are inadequate. 



A modified hypothesis may therefore be introduced, namely, that 

 tumor formation in the early stages is apt to induce hyperfunctioning of 

 certain parts of the hormone activities of the pineal ; these may accentuate 

 gonadal function and lead to macrogenitosomia precox. Later destruction 

 of the pineal will abrogate such function and cause the gonadal regressive 

 functions already discussed. Jelliffe has called attention to the possible 

 relation of the cachexia and anemia to heliotropic disturbances, and 

 Zandrens has associated the anemia in his case with possible gonadal 

 aplasia. 



Complete fiber tract studies of Zandrens case have not yet been made, 

 hence the neurological mechanisms are not further elucidated. Jelliffe 

 maintains that these must be better understood before any generalizations 

 will be valid. The time has passed when any strictly humoral hypothesis 

 will explain the highly organized animal man. This organization is pre- 

 eminently neurological, hence the problem is essentially to trace the 

 efferent stimuli from the pineal depots, first through Cajal's receptor 

 apparatus cells; then further learn what the connections are with other 

 vegetative efferent stimuli, and finally through the tracts coming to and 

 from the pineal work out the regulation mechanisms. As already stated 

 (Jelliffe and White, 1919) the hormones are only a type of tool active 

 at the metabolic level of the nervous system. They are servants, not 

 masters, of the nervous system. 



Boehm (1917) has recently collected the cases of pineal tumor pre- 

 senting sexual precocity as follows: 



