Text-book of nervous diseases for physicians and students / by H. Oppenheim.

Date:
1911
Catalogue details

Licence: In copyright

Credit: Text-book of nervous diseases for physicians and students / by H. Oppenheim. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    1431/1480 (page 1379)
    in the drum-stick fingers, which are regarded as a mild form of osteo- arthropathy (Bamberger), the bony swellings have been sometimes absent (Dennig,^ Litten), or there has been rarefaction of the end phalanges (Stoltzing). A congenital form also seems to occur (Oppenheim, Decloux, Lippmann, Lemercier and possibly an acroneurosis of this nature (Oppenheim). I have also observed the symptom in a case of congenital cyanosis. Future observations will show whether acromegaly can be sharply distinguished from osteopathy. In any case there are forms of this disease which differ from Marie's type (the affection has been called Marie's disease), and which we cannot at present classify (Daireoff, Hirtz, Gasne, and others). As regards so-called di/sosiose deido-cranienne, to which we have referred at another place, see also Villaret-Francoz, Notiv. Icon., xvii. ; Voisin, ihid. We have no certain knowledge as to the primary site of acromegaly. There are many indications that an affection of the hypophysis is the primary cause of the symptoms. Experimental observations by Vassale and Sacchi ^ seem to show that the hypophysis is a necessary organ, which supplies a specific product to the blood. This view is also held by Caselli * and Collin.5 Pirrone, on the ground of his own experiments, thinks it has an antitoxic function. Cyon regards it as an accessory organ of the thyroid gland : he found in it a chemical body which had an exciting effect upon the branches of the vagus to the heart. In a recent paper he thus defines his standpoint: All increase of the cranial pressure pro- duces mechanical stimulation of the hypophysis, which results in a stronger and slower beat of the heart; the rapidity of the venous circulation is thereby increased, especially in the veins of the thyroid, and the brain is thus relieved from the abnormal repletion of blood. The hypo- physis in addition produces substances which excite the vagus and accelerator centres, and thus increase the rate of the venous blood-supply. Cyon has also seen erections, polyuria, etc., in stimulation of the hypophysis. In acromegaly we are dealing, not with an increase or decrease of the function of the hypophysis, but with a fully developed disturbance of the function of this organ. See also Cyon, Les Fonctions de THypophyse, Acad, des Sc., 1907 ; Tliaon, abs. B. n., 1907, etc. Friedmann and Maas,^ on the other hand, say they have removed this organ from animals withovit producing any severe symptoms. Lomonaco and Rymberk have had similar results. They conclude from their experiments that the hypophysis is a rudimentary organ of no functional importance, its excision producing neither symptoms due to injury of the neighbourhood, nor those caused by shock or infection. Rossi and Corning have come to the same conclusions by means of morpho- logical analysis. Friedmann has also found that young, growing cats can dispense with the hypophysis. There is no doubt that tumour-like degeneration of this gland may exist without acromegaly developing. Of course the tumour in that case is as a rule a destructive one, whilst the tumours which produce acromegaly are usually associated with increase of the glandular tissue 1 M. m. W., 1901. ^ These de Paris, 1902. Arch. ital. de Biol, 1893 ; Riv. sper., 1894. Stud, anat., etc., della gland, pit., 1900. « Arch. ital. di bioL, 1899. « B. k. W., 1900 and 1902. ' Riv. mens, di neuropat., 1901.