HYPOPHYSIS CEREBRI 347 



left intact, it is obvious that, with the removal of the tumour the 

 obstruction of function was abolished, the latter being allowed to 

 resume its normal course. This supposition is rendered more 

 probable by the subsequent history of the case. The improve- 

 ment lasted for nearly three years, the symptoms principally 

 affected being those which had been caused by the tumour, while, 

 after the first amelioration, the general symptoms ceased to make 

 further progress. At the present time the patient is still of 

 infantile habit, and there is no appreciable reduction of the corpu- 

 lence. In three other cases of the same kind upon which v. 

 Eiselsberg operated successfully, the tumour symptoms and the 

 general condition were improved, but the state of the genital 

 organs and the corpulence underwent no progressive improvement. 

 The indication for surgical measures lies, not in the trophic dis- 

 turbances, but almost exclusively in the progressive signs of cere- 

 bral tumour, such as violent headache and threatening blindness ; 

 hence, if these symptoms show improvement, it is perfectly justifi- 

 able to describe the result as " satisfactory." In certain cases, 

 the operative removal of the tumour is undoubtedly the most 

 rational method of procedure. The results which have just been 

 described do not, however, disprove the significance of hypo- 

 pituitarism as a factor in the etiology of dystrophia adiposo- 

 genitalis. 



The results of organo-therapy in this condition are not 

 unfavourable to the hypothesis of hyposecretion. Several 

 accounts (Levy and Rothschild, Axenfeld, Delille) have been given 

 of the beneficial effect of pituitary extract upon the obesity and 

 the reduced sexual activity. On the other hand, there is a general 

 consensus of opinion that the exhibition of pituitary extract in 

 acromegaly is not only useless, but that in many instances it 

 aggravates the symptoms. 



In considering the diseases which originate in the hypophysis, 

 the fact is brought home to us perhaps more nearly than in the 

 case of the other internal secretory organs that disturbance of 

 the function of one organ is so intimately associated with dis- 

 turbance of the function of others, that it is sometimes difficult to 

 decide with certainty in which organ the primary pathological 

 affection is to be sought. As long as ten years ago, Pineles 

 pointed out the fact that there appears to be an intimate anatomical 

 and physiological interrelationship between the different blood 

 glands, which is manifested clinically by the fact that the patho- 

 logical disturbance of one gland is accompanied by symptoms 

 pointing to the functional derangement of one or more of the 

 others. Knowing, as we do, the many sided interactivity which 

 subsists between the different internal secretory organs, it is readily 

 conceivable that isolated diseases of single organs of this group 

 are very much rarer than, at a first glance, they would appear to 

 be. In the present state of our knowledge, the only course of 



