HYPOPHYSIS CEREBRI 317 



up the hypophysis from the, base of the cranium by way of the 

 oral cavity. The organ was usually destroyed either with a 

 thermocautery or by the injection of chromic acid; removal was 

 effected with spoon-forceps, generally of the operator's own 

 design. 



Lo Monaco and van Rynberk followed up Gley's experiments 

 with rabbits, the method they chose being from the vertex of the 

 skull. After opening the dura mater, these authors penetrated 

 between the hemispheres at a spot previously determined upon, 

 and after passing through the corpus callosum they reached the 

 infundibulum and from there they were able to reach the hypo- 

 physis. In twenty-eight cases out of forty-four they succeeded in 

 removing the hypophysis by this method. 



This method was very justly condemned by Paulesco ; he 

 pointed out that it is faulty in all essentials, for it inevitably pro- 

 vokes secondary lesions- of more or less grave a character, that it 

 is accompanied by serious risk of infection, and that it does not 

 properly accomplish what is, after all, the chief object of operation, 

 namely, the exposure of the organ. Paulesco (1906) introduced 

 a new method of hypophysectomy ; he employed the lateral 

 approach, beneath the temporal lobe. 



I have employed this method myself in a large number of 

 experiments. In my earlier experiments with cats, I used the 

 buccal method of reaching the hypophysis, but in the later experi- 

 ments with dogs which I carried out with Dr. M. Silbermark, we 

 invariably employed the intercranial operation. This method, 

 which was also adopted by Gushing, fulfils all requirements. 

 After practising upon the cadaver, we were able to perform the 

 operation with a considerable degree of certainty, and out of a 

 series of fifty animals we did not lose one from post-operative 

 haemorrhage, meningitis or sepsis. It may be remarked in pass- 

 ing that this method may be employed with equal success for 

 the purpose of exposing any structure at the base of the brain 

 in the median cranial fossa, and is especially suited to the inter- 

 cranial resection of the second to sixth cranial nerves. What is 

 fundamentally new about the method is that it permits of a con- 

 siderable dislocation of the brain without damage to it. An 

 opening of suitable size is made in the squamous portion of both 

 temporal bones, and the dura mater is opened upon both sides. 

 With a flat bent spatula the temporal lobe may now be lifted and 

 pressed to one side, without in .any way crushing the substance 

 of the brain. In a good light, after mopping out the cerebro- 

 spinal fluid, the hypophysis will be seen hanging like a berry on 

 a stalk in front of the optic nerve, by the side of the internal 

 carotid artery, and behind the oculomotor nerve. The organ is 

 now clearly visible under conditions eminently suited to operative 

 intervention. It may be severed from its peduncle and left free 

 in the cavity of the brain; or it may be entirely removed; or 



