D. D. December 1, 1881.] THE DUCTLESS GLANDS.?BY MATHEW O'CONNELL, M. 321
required till after birth ; 2?id, glands the secretions of ORIGINAL COMMUNICATIONS. which are not required till various periods after birth ; 3rd, parts the growth or development of which takes at certain after such as the THE DUCTLESS GLANDS. place periods birth, develop- ment of teeth in dentition and the growth of the ovaries By Matthew D. M. O'Connell, D., and testicles leading to menstruation, &c. This will be A. M. D. Surgeon indicated by a rough tracing of arterial supply which assumes one of two forms the first is that The functions of these bodies are not well understood, generally ; and there is not much in which the ductless gland is supplied by the terminal opportunity of studying some of branches of the main the which them, as they shrink at or about birth and gradually be- artery, as, pineal gland, receives the terminal branches of the cerebellar arteries. come smaller with advancing years, except when diseased. On account of this at In the tracing D. represents the pineal shrinking or after birth they following gland, as G. the cerebellum. have generally been looked on diverticula to the cir culation during foetal life. That this is their chief function is very probable, and an attempt will be made to more a render this apparent by more minute examina- of their vascular tion, supply and connections, than is generally given by physiologists when treating of these bodies. As the vascular supply of each gland is examined this will be applied to the explanation of certain clinical facts which are daily met with by physi- cians. But each cannot be gland considered satisfactorily because two or more by itself, appear to be united some- times in one effect. For producing example, the shrink- of the and ing thyroid gland tonsils would to appear the is affect the circulation in the In the second arrangement ductless gland sup- salivary glands and alveoli of and The circulation in the branches the main artery, (dentition). the .and mam- plied by proximal diaphragm either the muscles or a mary gland would be affected by the terminal branches supply shrinking of the thy- in bodies as is shown the following tracing roid, thymus, supra-renal and ovaries. The follow- secreting gland, classification is ing rough therefore suggested, founded on the vascular connections of these bodies. When bodies shrink certain new these functions become active ^ Pituitary body, influencing ophthal- mic circulation. Pineal gland cerebellar circulation. influencing C bral -I Tonsils influencing cerebral circu- lation. Thyroid glaud influencing cerebral found in connection with the circulation. This arrangement is thymus gland D., the diaphragm being represented by if., f Thyroid and G. The internal influencing respiratory and the mammary by mammary mammary gland functions. 4. Of course in each artery being marked examining 2 Thymus, do. do. relative importance of G. and if. j gland separately the Respiratory J Supra-renal, respira- that when the ductless and influencing will vary. It is evident gland ) tory, renal func- reproductive, more blood will be sent to the secreting Reproductive. ( tions. begins to shrink muscle which become gland ((?) or to the (M.), only Ovaries uterine func- of j influencing active after birth. It is known the ductless glands tion. in at that most of them are largo foetal life and shrink Tonsils sali- influencing dentition, birth, and that some of them shrink and enlarge periodi- vation, special senses. unless as for instance the spleen, and that Thyroid cally, influencing deglutition, diseased, they gradually contract with advancing years g I voice. until in extreme old age they have almost disappeared. Digestive. Spleen ductless j influencing gastric, pancrea- Having thus shortly referred to the glands tic, hepatic functions. be as to | collectively, each will now examined separately Solitary or Peyer's influenc- [ glands its arterial supply. ^ ing intestinal function. Class I.?Cerebral. is and If the arterial supply of these bodies be considered 1 st, Pituitary body.? This large vascular in the seen that at about birth. In the foetus it collectively it will be there is a certain eimi- foetus, and it shrinks to communicate with the third larity of arrangement in them all. They receive their contains a cavity said adult it does not. In Dr. Moxon s supply from arteries the other branches of which are ventricle. In the the distributed to?1st, muscles, the action of which ia not recent Croonian Lectures influence of the cerehro- 322 THE INDIAN MEDICAL GAZETTE. [December 1, 1881.
spinal fluid on the cerebral circulation is vividly describ- due to mental emotions, as sorrow or fright, &c. A ed. From this its influence on the cerebral circulation in good flow of tears is often known to cure a headache, the fcetws and On that of the pituitary body in particular 'lhere is one periodical function which is known to can be easily understood. The internal carotid artery depend on the vascular state of the cerebrum, viz, is large in the foetus, and its first branches are given off, sleep. There is ansemia of the brain during sleep, in its cavernous portion, to the pituitary body, and are but how this ansemia of the brain is produced is not named arteria receptaculi. The next branch given off known. Now seeing the intimate vascular connection is the ophthalmic artery which furnishes branches to (a) between the pituitary body, and cerebrum, it is suggested the muscles of eye, (b) the lachrymal gland, (c) retina, that there is a periodical enlargement and shrinking (d) part of the Schneiderian also called pituitary mem- of the pituitary body, producing, as it undoubtedly brane. The obvious effect of shrinking of the pituitary would diminution and increase of blood in the brain. body at birth would be to drive a larger supply of blood This enlargement is probably gradual, leading to cerebral to these parts, the functions of which then begin. The ansemia and sleep. When the congestion of the pitui- angle at which the ophthalmic artery is given off would tary body becomes excessive it perhaps becomes an render this alteration of vascular supply more effective. irritant leading to shrinking of the body, increase of "With regard to clinical experience it is known that blood to the brain and consequent awakening. (See Fig. I. Fig. II. fig. I). In this periodical enlargement and shrinking the pituitary body would resemble the other ductless glands,?the spleen, ovaries, tonsils, &c &c. But in the periodical production of cerebri] anosmia leading to sleep there are also perhaps engaged the pineal and choroid The positions at which the OA gland plexus. anterior and posterior choroid arteries are given off from the internal carotid and posterior cerebral are as suggestive as the origin of the arteries supplying the pituitary and pineal bodies. Again the influence of the cerebro-spinal fluid on the circulation in these bodies is very obvious. Its effect on the circulation in the choroid plexus has been shewn in Dr. Moxon's A, Internal carotid A. Vertebral affery.|artery. A. Vertebral artery.artery. lectures previously referred to. In the erect posture this B. Arteria Cerebellar receptaculi. B.B. Cerebellar artery.artery. fluid tends to gravitate towards the spinal canal, but also D. C. Pituitary body,body. 0. Cerebellum.Cerebellum. towards the anterior subarachnoid space of the brain. Tn op. Ophthalmic artery. D.D. PinealPineal Ophthalmic artery. body.body. this space it must exercise considerable pressure on the 0. Eye. pituitary body and keep it in a comparatively bloodless E. Brain. state. It gravitates, in the recumbent posture, from the certain diseases of parts supplied by the ophthalmic anterior subarachnoid space as also from the spinal canal artery are more common just at birth when this vascular and third and lateral ventricles towards the fourth ven- change occurs. There is the ophthalmia of infants. tricle, the canal between third and fourth ventricles Simple hypertrophy of the lachrymal gland is found being more perpendicular when the occiput is lowered. more frequently in infants or children than in adults, and This gravitation would admit of the expansion of the is said even to be congenital (Soelberg Wells). Dacryops pituitary and pineal bodies and consequent induction or cyst of the gland is also said to be congenital. Diseases of cerebral aneemia. Hence the recumbent posture tends of the muscles of the eye are also more common when to induce sleep. As Dr. Moxon has shown, the cerebro- the shrinking pituitary body is producing this vascular spinal fluid tends to accumulate in the 4th ventricle change, as for instance, nystagmus, which is often met in the recumbent posture* thus compressing the medulla with in conjunction with hipptis, strabismus, and also oblongata and retarding the circulation and respiration. with opacities of the cornea and lens and in albinos. If this periodical enlargement of pituitary and pineal Here also may be noted the more easily produced flow bodies takes place it only resembles the enlargement of tears from various causes in women and children. The of spleen, &c. peculiar disease exophthalmic goitre will be referred to 2nd, Pineal gland.?This is also a very vascular body presently. There is also a disease not uncommon in It is larger in the child than in the adult and larger in infants when this vascular change is taking place, viz. woman than in man, and is said to increase in size thickening and inflammation of the Schneiderian mem- during menstruation. Its cavity is said to communicate brane. This membrane from the supposed similarity with the third ventricle, and contains a transparent between its secretion and that of the pituitary gland, fluid and a sabulous matter. gave origin to the term pituitary being applied to the This body receives its arterial supply from the terminal gland. The ethmoidal branches of the ophthalmic sup- branches of the cerebellar arteries which are given off ply portion of the Schneiderian or pituitary membrane. from the basilar arterty and the vertebral arteries. The This will be again referred to under the heading tonsils. cerebellar arteries also supply the vascular velum inter- May it not be suggested that the pituitary body even in positum which is so closely connected with the pineal adults is not unconnected with the production of tears gland. A small branch to the tympanum is given off D. M. D. December 1, 1881.] THE DUCTLESS GLANDS.?BY MATTHEW O'CONNELL, 323
With to diseases. Cretinism and the disease from the basilar artery between the at which regard points are almost to children. And arise the and anterior called hydrocephalus peculiar superior cerebellar arteries. " o? the former Virchow says, that the abnormal Shrinking of the pineal gland would primary obviously cause' commences condition of the brain with the growth of the an increased supply of blood to the cerebellum. In bones of the basis cranii. and especially with the sphe- the infant the cerebellum j8 smaller than in the Now these the adult and the is noid and adjacent parts." bones, especially pineal body larger. As the latter receive their nutrieut arteries from the internal shrinks the former grows. In females the sphenoid, pinealcarotid where the arteria receptaculi are L'iven body is larger than in males and the just cerebellum is So here it would smaller. off to the body. be obvious Shrinking of the pineal gland would also pituitary in- this or which natu- crease the that contraction of body shrinking blood supply of the The tympanum. tympa- drive more blood to the bones num is also in takes would vascular connection with the tonsils rally place The this normal not take place tonsils more connected mentioned. Should shrinking being closely with the develop- would ment of or should the enlarge, the sphenoid receive the teeth and salivary wi]I body glandS) fae examined is known to be in the less blood. But this disease cretinism digestive class. However the effect of the four with of one du'ctless bodies (comprising the cerebral sometimes associated enlargement class) collectively on with are often the cerebral circulation will be the and cretinism there considered Thegland, thyroid, shortly of a close of blood to the associated altered conditions parts which have supply brain jB received th h as for the internal carotid and vascular connection with other ductless glands vertebral arteries. The latter arise from the subclavian instance deafness and pineal gland), dumbness artery almost at same (tonsils the su- as the absence of reproductive power (ovaries, point thyroid axis (giving 0ff jta lartre (thyroid), braQch tQ and strabismus the thyroid gland) and the internal pra-renal bodies,) blindness (pituitary which and the These nummary disorders of digestive system, (spleen solitary supplies thymus gland. two bodies sobody, being there is a constant to in the foetus would and in cretinism tendency large obvi0us y recejve the ter glands), also a disease almost confined of the blood in the subclavan In part artery and so diminish sleep. hydrocephalus, there is effusion into cerebral ventricles or the quantity poured into the vertebral. to childhood, Moreover the And the blood the of between the membranes. here again symptoms reaching cavity the cranium through are not the vertebral will be associated with this disease perhaps unconnected distributed to the chiefly Ia-te of the ductless The senses of pineal body in the foetus as this is with the state glands. body suppJie(1 b' ^ acute at the cerebellar arteries which are and become morbidly first, the first brancheg sight hearing are affected : is short and from the vertebral and basilar digestive organs sleep uneasy. arteries. Of the blood or amaurosis. which reaches the cranial xi be strabismus cavitvy 1 There may .., . . ., the internal ,, through that the cavities of the and pi- carotid, a not inconsiderable portion ~ * i , It is known pituitary , , must i ... .FU1Clon be in the foetus with the third to the in supplied neal bodies communicate large pituitary body the foetus th* fl. ? ' s So in the foetus the vascular state of these branches of the internal carotid arp ti ventricle. more effect on and be more aculi. Of the blood which flows bodies would have ?? , , . , ? i the , i ulro"gh afr'emexternal the amount of cerebro-spinal fluid. It is carotids, and which might read, the affected by brain through* the for whether these bodies the as a line inquiry, meningeal arteries, greater porl;(>n suggested woi||d ^ contracted in the of be supplied to the thyroid gland are found excessively subjects hy- a?d tonsi|s is found and ? Exophthalmic goitre frequently ascending pharyngeal superior are drocephalus. thyroid the first one vascular gland, the thyroid. It is al- branches given oft from the with disease of external carot;