Papers relating to the pituitary body, hypothalamus and parasympathetic nervous system / [Harvey Cushing].

  • Harvey Williams Cushing
Date:
1932
Catalogue details

Licence: In copyright

Credit: Papers relating to the pituitary body, hypothalamus and parasympathetic nervous system / [Harvey Cushing]. Source: Wellcome Collection.

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    stimulation of which will promptly induce a condition indistinguishable from sleep, points suggestively in this direction. Then, too, we have had before us, these past fifteen years, the all too common examples of lethargy associated with encephalitis, a malady whose effects are prone to strike at this particular part of the brain as shown by other symptoms unmistakably hypothalamic in origin. Accordingly, the not uncommon clinical states of periodic somnolence called narcolepsy, which are characterized, in the absence of any other symptoms, by periods of sudden irresistible drowsiness and weakness, are commonly regarded as post-encephalitic disturbances akin to Parkinsonism. And it is not without interest that patients, in whom these states of narcolepsy occur, oftentimes coincidentally become abnormally adipose. Pathological som¬ nolence is also prone to accompany such of the craniopharyngiomas as cause deformations of the third ventricle, but it is a still more common feature of what has been called the hypersomnic form of brain tumor29— namely, the gliomatous lesions that involve walls of the third ventricle. Thus it would appear that, pathological sleep, and conversely of course abnormal wakefulness, in all probability are states induced by a disor¬ dered function of the hypothalamus, but we cannot at the same time lose sight of the fact that somnolence is also a characterizing feature of many pituitary disorders in which the diencephalon can by no possibility have sustained direct damage. This is particularly true again of the chromo¬ phobe adenomas that are often associated with a notable drowsiness which sixteen hours of sleep out of the twenty-four will sometimes scarcely satisfy; and the fact that polyuria is rarely seen in these cases would fur¬ ther emphasize the fact that the adjacent tuber has escaped injury. There is another thing about sleep that deserves consideration—name¬ ly, its rhythmical periodicity. Cyclicism, which may be diurnal, lunar, or seasonal, is a peculiarity of many physiological processes. The unac¬ countable periodicity of oestrus and of menstruation, of rutting, and of hibernation are examples. That these cyclic occurrences are primitive and fundamental to the species is beyond question. The sloth awakens merely to take food and procreate. Hibernating or estivating creatures pass whole seasons unfavourable for sustenance with their metabolic processes so far slowed down they can survive meanwhile on their own tissues. That these processes are somehow under the control of this an¬ cestral diencephalo-hypophysial apparatus seems most probable. Some years ago (1915) the attempt was made in collaboration with Emil Goetsch30 definitely to pin hibernation on the pituitary body, but our opportunities for putting it to a conclusive test were inadequate. Unquestionably the secretory apparatus that controls tissue metabolism must be essentially inactive during hibernation just as it is relatively so in hypopituitary states. And since the hypophysis plays an even more 29 A series of striking cases of this sort has been reported from the writer’s clinic by J. F. Fulton and P. Bailey, Jour. Nerv. and Ment. Dis., 1929, lxix, 1, et seq., with complete bibliography of the subject. *n Jour. Exper. Med., 1915, xxii, 25.