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grounds normal except for narrowing of arteries — arteriosclerotic. .V ray examination reports. — "A radiographic ex- amination of Cheap Cialis Canada the skull shows the sella turcica very small, the posterior Cheap Cialis Canada clinoid process wide and indis- tinct in outline. There is, however, no evidence of erosion. There is also an unerupted canine; the uiierupted molar is transverse to its usual position." "A radiographic examination shows distension of the anterior joint spaces of both knee joints some- what more marked on the right side. There is no irregularity in articular outline. The findings are those of a synovitis." Urinary examination gave an amber color, spe- cific gravity ranging from 10.10 to 10.23, amount from 1,050 to 1,500 c. c. No sugar until the 4th of May and no albumen until the 4th of May. No albuminuria and no glycosuria was observed until the 4th of May. when pituitary extract of anterior lobe was injected intramuscularly, and on that day appeared sugar in the urine ranging thereafter from .83% to 1%, albumen being present in faint traces. The maximum blood pressure was 220 systolic, 155 diastolic : the minimum being 160 and 80. Two cc. of pituitary extract of anterior lobe were in- jected, followed in twenty minutes by one cc, and the pulse, temperature, and blood pressure were taken every fifteen minutes for one and a half hours and then every half hour for two hours. After the first injection there appeared within fifty minutes a fall of ten mm. of Hg., and after three hours the systolic pressure was 220, the diastolic 150 with symptoms of dizziness which lasted for four hours. FRANTZ: POLYGLANDULAR DISEASE. 1031 Cheap Cialis Canada The temperature at the maximum point of pressure went down Iv^o tenths, the pulse going down from 100 to eighty-three at the maximum pressure. Cheap Cialis Canada Twenty-four hours after the first injection the sys- tohc was 180, dystolic 120, pulse 120 or in inverse proportion. No thermic reaction was observed. It must be borne in mind that the glycosuria and the albuminuria immediately followed the Cheap Cialis Canada injection of ]jituitary extract (anterior lobe and persisted daily after that. No definite ratio was obtained between the lluid intake and outinit, such figrues as these re- sulting: intake 600, output 375 cc. ; intake 600, out- put yoo; intake Cheap Cialis Canada 1,040, output 970; intake 600, out- let 1,140; intake 840, output 1,350; intake 1,000, output 1,770. After the injection the intake was 1,240, out[)Ut 1,500; intake 1,300, output 1,050; in- take 2,240, output 1,495; intake 1,410, output 1,140. As observed there was some polydypsia and polyuria after Cheap Cialis Canada the injection, but a distinct glycosuria and al- buminuria. it appears to me that this is a case of polyglandu- lar disease and that we have a condition suggesting a flisturbance Cheap Cialis Canada of five Cheap Cialis Canada of the more important glands of the endocrinal system. We must of course bear in mind the so called classical Frohlich Syndrome which is defined by Dana "as a disease of the pituit- ary gland characterized by stunting of growth, adiposity, and hyijoplasia of the genitals." Gushing del'incs the syndrome as an expression of infantilism of the structural and sexual associated witii adiposity of the juvenile type and hypophyseal tumcr. (According to Dana's definition as well as Cushing's we have here not a typical Frohlich with its well distributed adiposity, but adiposity limited only to the head and trunk.) Marburg divides cases of I'^rohlich syndrome into: simple adiposity; adi- posity with genital atrophy, and simple genital atrojiiiy. Analysis of our findings brings these facts to view : the sudden onset of adiposity Cheap Cialis Canada limited to the face and trunk, hair well grown from the eyebrows to the temporal region, hair over the back, flushed thymus, high blood pressure 185-IJO, underdevelop- ment of tlie extremities, tendency for ecchymosis to form easily, underdeveloped genitalia, tapering fingers, drowsiness, easily fatigued, pains in the back and legs, and certain degree of asthenia, lack of sex vigor, and feminine voice. Face, dry skin, a certain an.dunt of duhvjss persistent. Suggesting hypopituitarism we have the adiposity, tapering fingers, underdeveloped genitalia, and small >;ella turcica, as evidenced by the Rontgen gram. Pointing to adrenal disturbance we have asthenia, Cheap Cialis Canada tenCheap Cialis Canada to thymus, there is a certain amount of retrosternal dullness. Hy fluoroscopic examination a Cheap Cialis Canada persistent thymus was made out. Referring to Cheap Cialis Canada a disturbance of the |)arathyroid we may think of the increased coagula- bility of the blood and increased calcium content. Gushing found in his experience that in condi- tions of hvpopituitarism the testes are small, secondary sex changes are absent, there is an insuffi- ciency of the adrenal and hypoglycemia. Histologi- cal changes in adrenal tissue show abnormal vaculi- zatioii (lipoid change) in the cells of the zonia fasciculata of the cortex. The thymus is jiersistent as a rule. In cases of hypophyseal insufficiency there is apt to be a persistent and enlarged thymus when the process dates from the preadolescent era. Gushing found after an injection of pituitary ex- tract (anterior lobej an increase of from one and one half to two degrees in temperature. As far as I could find in the literature there is only one case quite similar to this under discussion. This is Cheap Cialis Canada re- ported by Gushing in his book on The Pituitary Body and Its Disorders, published Cheap Cialis Canada in 1910. He tells of a young girl twenty-three years old who was re- ferred to hnn because she began to take on weight suddenly. The history showed that menses began at fourteen years and came at regular intervals for seven years when it stojiped. The patient got a temperature, headaches, pain in the back and swell- ing of the feet. Her vision began to fail and periods of diplopia, nausea, and vomiting began to occur associated with more severe headaches. She be- came stout gradually and in two years acquired twenty-five pounds. There was a falling out of the