Clinical Syndromes Involving the 

 Pineal Gland 



GILBERT HORRAX 



BOSTON 



Introduction 



Paucity of Pertinent Data. Our knowledge of the clinical symptoma- 

 tology which is associated with disorders of the pineal body (epiphysis 

 cerebri), has been built up from a study of about seventy-five case re- 

 ports in which varying clinical symptoms have been associated with some 

 definite pathology of the pineal as shown at autopsy. These meager data 

 have accumulated during the past 120 years, starting with the record 

 published by G. Blane in 1800. In almost every instance, the reports 

 deal with tumors of the gland, the exceptions being two cases of hemor- 

 rhage described respectively by Simon and by Ziegler ; one case of abscess 

 by Birch-Hirschfeld (quoted by Marburg) ; and one case of syphilis by 

 Lord. In one other case, reported by Pontopiddan, the author was unable 

 to make an exact diagnosis as between syphilis and sarcoma. 



Owing to the recent clinical studies by v. Frankl-Hochwart, by. Mar- 

 burg^), and by Bailey and Jelliffe and to the experimental work of Foa 

 (c), Sarteschi(6), Dandy, McCord(a), and Horrax, special significance 

 attaches to the occurrence of pineal disease in individuals before the age 

 of puberty. Of the cases recorded, twenty-three (or about one-third) have 

 dealt with children under fifteen years of age, but only in eleven of these 

 are there given sufficient clinical data upon which to base any conclusions. 

 In addition to these authenticated cases, three others cited by Gushing, one 

 reported by Morse, and two by the writer, have shown symptoms and signs 

 of probable pineal involvement, but of course our knowledge here is purely 

 speculative. 



Rarity and Incidence of Pineal Disease. It may be said, therefore, 

 that disease of the epiphysis is very rare, and that the pathology is con- 

 fined almost exclusively to tumors. Incidence of disease is twice as fre- 

 quent in adults as in children, but it is only in cases which occur before 

 the age of puberty that we see evidence of certain constitutional changes 

 which it is thought may be connected with a disordered secretion of the 

 pineal body itself. 



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