TUMOUR OF THE PITUITARY GLAND.

TUMOUR OF THE PITUITARY GLAND.

401 three parts, the chief of which occupied the sella. Prolongations from this passed forwards into the orbital cavities and its dorsal part projecte...

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401 three parts, the chief of which occupied the sella. Prolongations from this passed forwards into the orbital cavities and its dorsal part projected into the third ventricle between the cerebral peduncles. Small nodules of growth were situated around the margins of the tumour and the whole mass was encapsuled in a tough membrane like the dura mater. There was no remnant of the pituitary gland. The tumour was a sarcoma. The cerebral substance in contact with its margins showed a slight degree of local softening, and a portion of the neoplasm itself had undergone softening as the result of a hyaline degeneration of its vessels. In the course of its growth forwards it involved the optic chiasma slightly, more on one THE MEDICAL DIRECTORY : THE DISTRIBUTION side than the other; hence the amaurosis on the one side, combined with hemianopsia on the other side. As the OF THE MEDICAL PROFESSION. THE Medical Directory for the year 1900 has just growth continued to increase the involvement of the other nerve was complete and hence total blindness resulted. appeared, the issue of this invaluable work of reference optic It is interesting to record that the patient showed a moderate having been delayed on account of a fire which occurred at the printers’ establishment towards the end of last year. degree of hypertrophy of the feet and hands and of the face, The total number of practitioners for 1900 is 35,651, an the augmentation of volume in these organs producing an increase of 657 over the total for 1899, which was 34,994. appearance like that of acromegaly. The enlargement was This, at least, was the total given in the 1899 edition, practically limited to the soft parts, the bones apparently not had a feminine type of although in the tabulated statement published in the suffering enlargement. The patient and skeleton the sexual showed insufficient developorgans 1900 edition the total for 1899 is given as 35,117, and hence the patient had a Pechkranz thinks that ment (hypoplasia). the increase for 1900 is only 534, but the discrepancy in of his the structure pituitary body probably arises from the taking in of those qualified during congenital anomaly 1899. Continuing the comparison of figures for the two and regards the condition of the skeleton, of the sexual and finally of the hands, face, and feet as associated years 1899 and 1900 and taking as our authority the tables organs, with the abnormal condition and eventual destruction of the in the 1899 and 1900 edition it is possible that decentralisation is proceeding. This is a movement which has long pituitary body. been prophesied as about to happen, and it may ha ve begun THE VALUE :OF BACfERIOLOGICAL EXAMIthough the figures are not conclusive. The figures for NATIONS TO THE COMMUNITY, London in 1899 were 6117 ; in 1900 they are 6102. ProAT the last meeting of the Lambeth Vestry on Thursday vincial England for 1899 showed 15,497 ; in 1900 the figures are 15,794. For Wales the figures in 1899 were 1100; in night the medical officer of health, Dr. Joseph Priestley, 1900 they rise to 1127. Scotland in 1899 had 3394 practi- presented a report made to the Sanitary Committee showing tioners and in 1900 has 3462. Ireland in 1899 possessed 2551 the result of the first year’s working of the bacteriological and in 1900 the figure is 2559. Practitioners living abroad laboratory recently established by the vestry. Bacterioin 1899 numbered 3795, and in 1900 their total is 3875. logical outfits were supplied to medical practitioners in The services in 1899 mustered 2528 medical members and in the parish and examinations made free of charge. A total of 1900 the list rises to 2705. The "too late list" for 1899 388 examinations were made during the year. 214 examinanumbered 12, and in 1900 rises to 27. We are glad to see tions were made in suspected cases of diphtheria ; the true that an alphabetical arrangement has been adopted for diphtheria germs were found in 99. In 81 cases of suspected typhoid fever, 43 gave the Widal or typhoid reaction. the list of the hospitals. That is to say that bacteriology determined the diagnosis in 46 per cent. of suspected cases of diphtheria and 53 per TUMOUR OF THE PITUiTARY GLAND. cent. of suspected cases of typhoid fever. Dr. Priestley in S. PECHKRAKZ1 contributes a paper on the above and gives his report concluded that there Bvas thus a saving in an account of clinical observations made throughout the notification fees sufficient to justify the provision of the history of the case from the first onset of symptoms two and bacteriological laboratory. a half years before death. The patient, a young man, aged 27 years, suffered at first from troubles which were supposed to SPLENIC ANÆMIA COMPLICATED BY DIABETES be of renal origin and of a urasmic nature, but the absence MELLITUS. of œdema and of urinary indications negatived this view. IN the Journal of the American Medical Association, Both syphilis and tuberculosis could also be excluded. He Dec. 30th, 1899, Dr. H. A. Hare has published a case of suffered from headache, and this was followed by troubles of splenic anagmia complicated by diabetes mellitus which vision in the course of which one eye became completely appears to be the only one on record. Splenic anaemia is blind while the other was simultaneously affected with still a comparatively new disease and only a limited number hemianopsia. At a slightly later stage there developed a of cases have been recorded,l EO that it is impossible to say double optic atrophy. The two oculo-motor nerves werei whether this association is common or not. Whether in the next attacked and an almost complete ophthalmoplegia case in question there was any connexion between the two (internal and’ external) followed. There was no in- conditions Dr. Hare cannot state. The patient was voivement of any other sense, and there was coma man, aged 24 years, who was admitted to hospital plete freedom from localised paralysis or convulsions. A in 1895. He complained that in July he had begun diagnosis of neoplasm at the base of the brain affecting the to suffer from severe pain beneath the left clavicle optic chiasma was made. The necropsy revealed the following which extended downwards into the left hypochondrium. conditions. The pituitary gland was replaced by a large He was exceedingly pale; his conjunctivas were yellow tumour, no part of which was adherent except to a spot at: and his spleen was enormous. There were haemorrhages into the back of the sella turcica. The tumour was composed of: both retinae. In the blood there was a excess of this account tuberculin might be put to and that therefore stringent restrictions to be placed upon its sale, only duly accredited ought persons being allowed to purchase it. As regards the "curative" property of tuberculin it was considered that none of the experiments gave encouraging evidence. the experiments traversed ground which is now Although well trodden they are of great value in confirming fairly what has already been done to prove the diagnostic reliability o tuberculin and in bringing the position of modern knowledge under the eyes of the Cheshire agricultural community. out that dishonest

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Neurologisches Centralblatt, No. 18, 1899.

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THE

LANCET, Jan. 13th, 1900, p. 115.