HYPOPHYSIS CEREBRI 335 



the bones. Judging by this, the increased development of the 

 " acral " portions is to be interpreted, not as a sign of reduced, 

 but rather as the manifestation of an intensified, functional 

 activity. But it is a remarkable fact, that the extirpation of the 

 hypophysis of animals produces results in one direction, which 

 are similar to those brought about by acromegaly in man ; both 

 lead to arrest of development, and particularly to defective function 

 on the part of the sexual glands. 



A second hypothesis, first^propounded by Tamburini, regards 

 acromegaly as the result of two pathological processes in the 

 hypophysis. There is at first hypertrophy, leading to hyper- 

 function of the organ, and this explains the signs of increased 

 growth in different parts of the body. The second phase consists 

 in degeneration and reduction of functional activity, which pro- 

 duces the cachexic symptoms observed in the later stages of the 

 condition. The assumption of a hyperpituitarism, of an increased 

 internal secretory activity on the part of the hypophysis, was 

 supported by a discovery of Benda's, since confirmed by others, 

 that, in certain cases of acromegaly, the diffuse hyperplasia and 

 hyperplastic adenoma, commonly known as struma, show not only 

 regular increase in the number of the cells, but also a remarkable 

 multiplication of those eosinophile cells, which Benda regards as 

 the active functional elements of the hypophysis. A case of 

 acromegaly described by Lewis is particularly interesting in this 

 connection, for here, though the macroscopic appearance of the 

 hypophysis was normal, the microscope showed that the number 

 of the eosinophile cells was increased. 



Benda, who regarded the hyperplastic proliferation of the 

 chromophile cells as the cause of increased hypophysal secretion, 

 was at first inclined to support Tamburini's theory. In a later 

 publication, however, he modified his view. He pointed out that 

 it is not possible to regard the clinical course of acromegaly as 

 assuming two distinct phases, for in the classical form of the 

 disease, malignant acromegaly, the development of the tumour in 

 the hypophysis is intimately associated with the derangement of 

 growth and the general deterioration of the organism. Benda 

 regards the developmental disturbances as constant, but purely 

 symptomatic, accompaniments, and defines the true primary 

 disease as a tumour-like, connective tissue new formation, having 

 an undeniable resemblance to myxoedema and elephantiasis; he 

 ascribes the pathological symptoms to the excessive supply of a 

 secretion of specific toxic action, the function of which, under 

 normal conditions, is unknown, but the over-production of which 

 produces serious lesions of the tissues of the body. Benda believes 

 that the granules resembling zymogen in the chromophile cells 

 represent the secretory product of the hypophysis. 



The absence of any foundation for this last assumption, to- 

 gether with a critical appreciation of the known facts, led Cagnetto 



