Gumma of the Pituitary Body

Abstract

An eminent general surgeon referred a child to me, Nov. 5, 1908, for operation for congenital dislocation of both hips. The patient had been referred to him by an ex-interne of Cook County Hospital practicing in a distant state. Fig. 1.-Profile view of patient in whom both femoral heads and necks were absent.This is the typical attitude of severe double congenital dislocation of the hips. Fig. 2.-Rear view of patient, showing rachitic ankles and knees, as well as the prominent hips characteristic of double congenital dislocation hips.Fig. 3.-Radiograph showing congenital a bsence of head and neck of both femursThe patient was a female child, aged 7\ m=1/ 2\years. Her attitude in standing and walking was typical of bilateral congenital dislocation of the hips (Figs. 1 and 2). The hips were prominent; the greater trochanters showed with unusual distinctness; there was marked lordosis of the lumbar spine; the child waddled when she walked; the adduction of the legs was limited; the lordosis could be corrected by flexing both thighs to 50 degrees or one thigh to 90 degrees.The child had rachitic enlargement of the bone ends at the wrists, ankles and knees, and there was a moderate degree of knock-knee. She had pigeon-breast and flaring lower ribs, and the head and face were of rachitic type. Six weeks before this child (her sixth) was born, the mother had had a severe attack of influenza, followed by a "sore back," and inability to stand straight. The child was nursed for the usual period, had first teeth at the usual time, and walked at fifteen months.A careful manual examination failed to reveal a femoral head on either side; and because of the rachitic evidences present I believed, the case to be one of extreme rachitic bilateral coxa vara.To establish this diagnosis I had an jr-ray picture made; this showed ( Fig. 3) not a coxa vara but a complete absence of the head and neck of the femur on both sides.Patient.\p=m-\P. M., an Irishman, aged 37, single, entered hospital in 1908, in an unconscious condition, with a history of having had an apoplectiform attack. It was reported by his friends that he had had syphilis.Examination.\p=m-\The patient was a well-developed man with sandy hair and beard, apparently 50 years old. There was ptosis of the left upper eyelid. His face was pale; his lips very pale. There were sordes on the teeth and lips; the tongue was moist, swollen and coated. The pupils reacted to light. The thorax was deep and well muscled. There were a few diffuse, moist, large and small r\l=a^\les.The abdomen was apparently normal. The skin was cold and moist. The patellar reflexes, when first examined by an interne, were reported as normal or slightly increased, but were not elicited at any subsequent examination. The pulse was 80, weak and of low tension; the respiration 22; and the temperature 36.8 C. It was not possible to get an area of absolute dulness in the cardiac region with the patient in a recumbent posture. The apex beat was not seen. The heart sounds were pure and distinct, but weak. The uri...