The pituitary gland is far more frequently the subject of disease than the other hypophysis. Morbid processus, especially those which are deeply seated, have their site in its anterior vascular lobe.

1. Anomalies In Size

Increase in the volume of the pituitary gland may result from congestion, inflammatory swelling, and abscess, or from the presence of an adventitious growth. I have never observed any actual hypertrophy of the gland.

Atrophy, on the contrary, is not unfrequent. It accompanies, in old persons, the same affection of the brain. It prevails especially in the posterior lobe, which, besides diminishing in size, becomes loosened and pulpy (softened), and discolored to rusty brown, or yeast-yellow. At the same time the anterior lobe becomes pale, withered, and tough. Moreover atrophy is sometimes produced, in cases of chronic dropsy of the ventricles, by the pressure which is exerted upon the gland by the serous effusions, through the medium of the third ventricle.

The infundibulum, in like manner, usually shares in the atrophy, and becomes pale, withered, and thin.

2. Diseases Of Texture

1. Hyperemia

Congestion of the pituitary gland is generally combined with the like condition of the pia mater; but in young persons it is occasionally observed alone. It occupies the anterior vascular lobe, and the infundibulum. The cluster of vessels descending on either side of the latter, to the gland, is injected, the substance of the infundibulum is redder than natural, and the turgid gland is loose in its texture, dark red, and full of blood. In some very rare instances the congestion leads to apoplectic extravasation. I have observed small streaks of it associated with congestion of the membranes.

The gland is anaemic in cases of anaemia of the membranes.

2. Inflammation

This process also, so far as I am aware, is confined to the anterior lobe. The appearances which distinguish it are swelling, dark reddening, and looseness of the texture of the gland, but more particularly exudation. This last is usually a yellow, fibrinous product, with small points of which the gland is dotted; or which collects in spots, of the size of millet, or hemp-seed, or runs together in larger masses. Suppuration may take place in these masses, and give rise to abscess of the gland; and this, by the advance of the inflammation in the adjoining parts, may enlarge, and attain a considerable bulk. I have seen cysts of this kind, from the size of a hemp-seed, to that of a hazel-nut. If the inflammation in the adjoining parts terminate in callous induration, the abscess becomes encysted.

3. Adventitious Growths

The disease of this class which I have observed in the gland, are tubercle and cancer.

a. Tuberculosis of the gland is, on the whole, a rare disease. It occurs only in combination with tubercle in other organs, especially in the lungs and brain. It assumes both the form of gray crude granulation, and that of a mass of yellow tubercle, which softens and suppurates.

B. Cancerous productions are proportionally more numerous; indeed they are the most common of all the important diseases of the organ. In every instance which I have observed, the growth was of the medullary kind. In one case, in particular, it was a lobulated encephaloid, of a loose, creamy structure, enclosed in a fibrous (neurilemmatous) cyst. In a second case, it was a vascular, reddish-brown, and elastic, but firm medullary growth; while, in a third case, a similar growth was found, degenerated into a brown, chocolate-colored fluid, and contained in a neurilemmatous sac, which projected into the pharynx through an opening it had formed in the base of the skull, by destroying the body and part of the greater wing of the sphenoid bone. In several cases the growth had reached a considerable size, and the base of the skull was destroyed, and the brain displaced upward and laterally, to a corresponding and very marked extent.

The growth in this gland was, in several cases, the only example of the disease in the body; whilst in others, on the contrary, it was associated with cancerous formations in other organs.

y. In conclusion, there is a morbid growth, belonging to the class of adventitious productions, which consists of a gummy or glutinous (colloid) substance of a yellow color like citron or yellow wine, and occupies the cellular interstice between the two lobes of the gland. If a horizontal section be made, dividing both lobes in half, this growth will be found to form a layer between them, from a quarter of a line to a line in thickness, and sometimes to force the lobes asunder.

The growth in question has acquired importance from the brothers Wenzel having asserted that it was the cause of epilepsy. I have made frequent examinations of the gland, with reference to this assertion; but have as frequently failed to discover the disease in those who had notoriously suffered from epilepsy and convulsions, as I have met with it in other individuals who had been thoroughly healthy.

The Pineal Gland

The pineal gland is rarely the subject of disease, not only in a general point of view, but even in comparison with the pituitary gland. Its affections are also slight and unimportant. They are confined to:

1. The production of the yellow sand (acervulus) at too early an age (the proper date is fixed by Sömmering at 14 years), and its existence in great quantity, or in large confluent masses; and:

2. Enlargement of the cavity of the gland, and its final conversion into a membranous sac as large as a pea or a hazel-nut, or even still larger. There is usually, in such cases, a large quantity of sand scattered in the wall of the cyst: it is accumulated near the peduncles, where the wall still remains parenchymatous, and it gives the cyst some appearance of being ossified. This change is always associated with a certain degree of chronic hydrocephalus, and with thickening of the lining membrane of the ventricle.