936 CHARLES E. DE M. SAJOUS 



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and pathological anatomical studies of Pierre Marie of Paris that proved 

 the relationship of the pituitary gland to these disorders. When the over- 

 activity of the hypophysis cerebri occurs hefore the epiphyseal lines of the 

 long bones are closed, gigantism develops ; when the overactivity does 

 not occur until after the closure of the epiphyseal lines, acromegaly 

 develops. 



Important contributions to the surgical treatment of acromegaly have 

 been made, as every one knows, by practitioners of surgery in America, 

 Harvey Gushing, Charles Frazier, and others. 



Dystrophia Adiposogenitalis. In marked contrast with the clinical 

 phenomena accompanying overactivity of the hypophysis cerebri are 

 those that appear when there is underactivity of this gland. A striking 

 form of obesity associated with genital dystrophy and hypotrichosis (the 

 so-called Frbhlich syndrome, or hypophyseal dystrophia adiposogenitalis) 

 is now generally recognized as being due to insufficiency of the pituitary 

 gland. 



This insufficiency of the pituitary gland sometimes (though not al- 

 ways) depends upon hypophyseal tumor, in which case deformations of 

 the sella turcica (recognizable in radiographs) and pressure phenomena 

 (symptoms of general increase of intracranial pressure, or, more often, 

 neighborhood symptoms) accompany the syndrome. 



Some progress has been made of late in distinguishing the form of 

 obesity due to hypophyseal disease from that dependent upon insufficiency 

 of the thyroid gland or of the sex glands. 



Tetany. The clinical syndrome known as tetany, recognized first in 

 children early in the last century by Scottish and English observers and, 

 later, in adults by French and German clinicians, was carefully studied 

 in many of its manifestations long before its endocrin origin was sus- 

 pected. The peculiar paroxysms of tonic spasm, the increased excitability 

 of the peripheral nerves, especially of the motor nerves, to galvanic stimu- 

 lation, the Trousseau phenomenon, the Chvostek phenomenon and many 

 other features of tetany were fully described even before the parathyroid 

 glands were discovered by Sandstrom. The occurrence of tetany after 

 operations for goitre was commented upon by practical surgeons who did 

 not then know that in addition to removing the thyroid gland at their 

 operations they were removing certain other structures whose absence 

 was responsible for the development of the tetany. In the elucidation 

 of the origin of such post-operative tetany histologists and experimental 

 physiologists and pathologists have made brilliant contributions. Here 

 we see a notable example of the help that the medical practitioner can 

 derive from the work of the experimenter, for it was the latter who showed 

 that removal of the thyroid alone does not cause tetany, that removal of 

 the parathyroids alone is always followed by tetany in human beings and 

 in many animals, and that postoperative tetany depends upon simul- 



