904 WALTEK TIMME 



given better results than epinephrin, although the latter, either hypo- 

 dermically or (even against the dictum of the pharmacologist that it is 

 inert when administered per os) by mouth in larger doses is good to tide 

 over exceptionally bad days of fatigue and exhaustion. But the prime 

 agent the author believes almost a specific one is pituitary gland in 

 some one of its varied forms. Whole gland feeding in fairly large doses 

 (2 to 3 grains t.i.d.) may be given in appropriate cases. But usually the 

 dosage should be much smaller and given at greater intervals; one-half 

 or one-quarter grain every second or third day has given success in sev- 

 eral patients. Occasionally, pituitrin hypodermically 0.50 to 1.00 c.c. 

 per day or alternate days for one or at most two weeks, at a time is 

 excellent as supplementing the feeding of pituitary gland. Occasionally, 

 in cases with pronounced genital delay, anterior lobe pituitary gland 

 gives fair results. In those cases with vagotonic symptoms, hyperacid- 

 ity, and conditions resembling gastric ulcer, atropin in doses to physi- 

 ologic tolerance is indicated, and gives results. But the pituitary feeding 

 in itself alone produces highly satisfactory improvement in many cases. 

 Under its use the headaches disappear, the fatiguability diminishes, 

 the blood pressure and blood sugar content increase, and the case goes on 

 to cure. Gradually the pituitary feeding can be diminished and finally 

 discontinued. In the older cases, in which the sella persists in remaining 

 small (T. R., Fig. 10, and J. S., Fig. 11), constant feeding would seem 

 to be necessary; at all events, the patients relapse as soon as treatment is 

 stopped. Indeed, the patients themselves reach that point of accuracy of 

 judgment in feeding the gland to themselves that they can determine the 

 size and frequency of the dosage necessary to maintain them comfortably. 



Endocrin Disorders in Association with Muscular 



Dystrophies 



Historical. Early investigators of the progressive muscular dys- 

 trophies of the school of Charcot had at first placed them in the class 

 with the atrophies and had thought the spinal cord to be the pathological 

 focus of the disturbance. Then after several necropsies, especially one 

 published by Lichtheim in 1878, of cases showing high-grade muscular 

 atrophy in which no cord changes or peripheral nerve changes were 

 demonstrable, opinion began to veer to the position that this second type 

 was distinct from the one showing anterior horn changes in the spinal 

 cord. This second group showed unmistakable evidence, in the muscular 

 system itself, of disease; thus, the muscles show a large amount of fatty 

 tissue between the muscle fibers. The muscle nuclei are increased in 

 number and grouped together. There is splitting and vacuolization of the 



