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SwANZY — Note on Magmth's Defective Vision. 525 



temporal, side of each field of vision. Later on one or both eyes may 

 hecome quite blind. In the early stages of acromegaly, the patient 

 suffers little inconvenience, and it is often defective vision which first 

 induces him to seek medical advice. Now, amongst the post-7nortem 

 appearances of the disease none is more striking or more characteristic 

 than a hypertrophy of the pituitary body, or hypophysis, which is 

 situated in the pituitary fossa, or sella turcica, on the inner side of the 

 base of the skull, and it is universally admitted that it is this hyper- 

 trophied pituitary body which, by its pressure on the optic commissure 

 lying in close anterior relation to it, causes the loss of power in the 

 inner halves of the retina, for the commissure contains the crossed fibres 

 of the optic tracts destined for that part of each retina. But in Magrath's 

 skull, an examination of the sella turcica can leave no doubt that, in 

 his case too, the usual alteration in the hypophysis was present in an 

 extreme degree. This is evidenced by the enormous size of the 

 pituitary fossa, the result of absorption of bone on all sides of it, a 

 condition which is described by Professor Cunningham in the following 

 words : — " The expansion has been carried to such an extent that it has 

 led to the total obliteration of the sphenoidal sinus, and at one point in 

 the floor there is an elliptical pei-foration about one quarter inch long, 

 through which the fossa would communicate directly with the cavity 

 of the nose, were it not covered on the under surface by the expanded 

 ala of the vomer bone. The floor of the pituitary fossa exhibits a 

 number of deep depressions or loculi separated from each other by 

 salient smooth ridges. From this we may infer that the under aspect 

 of the greatly enlarged hypophysis was lobulated. The dorsum sellae, 

 which forms the posterior wall, is very nearly completely absorbed. 

 Only the basal part remains, and this is reared erect, and is as thin as 

 paper." E'ot a trace is left of either of the posteiior clinoid processes. 

 In front, and this is the point which, in the first instance, interests us 

 here, "the olivary eminence is completely gone, and the anterior wall 

 of the fossa, formed by an exceedingly thin lamina, bulges forwards so 

 as to encroach upon the nasal cavity. This portion of the cavity 

 extends below the posterior part of the floor of the anterior cranial 

 fossa. On the left side the fossa is bounded by a thin lamina, on the 

 outer side of which there is the groove for the internal carotid artery. 

 On the right side there is no such limitation, and the appearances are 

 such that I am inclined to believe that the enlarged pituitary body 

 bulged outward so as to enclose the right carotid artery, and even 

 extended forwards through the sphenoidal fissure into the back of the 

 right orbit." The dimensions of the pituitary fossa Professor 



