Loewy and Richter: Archiv für Anat. u. Physiologie, Supplement, 1899, and Berliner klin. Wochenschrift, 1899. The action of the pituitary body upon metabolism has been shown by Narbuth, who found a diminution of oxidation after degeneration of the pituitary body, and an increase after medication with extracts of the same organ. This fact is also shown clinically by cases of obesity after degeneration of the pituitary body in acromegaly, and by the interesting fact (shown by a great number of authorities and recently by Fröhlich,[39] Berger,[40] and Erdheim[41]) that cases of pituitary tumor may be met with, associated with obesity, and without any of the symptoms of acromegaly. Especially interesting is the case of Madelung[42] showing a colossal obesity in a girl aged 9 years, after a gunshot injury of the pituitary body. This observation sustains, and is clearly explained by, Sajous[43] who showed that the posterior or neural lobe of the pituitary body contained a nerve center which governed the functional activity of the thyroid, and that the secretion of the latter insured the catabolism of fats by increasing their vulnerability to oxidation. Footnote 39: Wiener klin. Rundschau, p. 78, 1901. Footnote 40: Zeitschrift für klin. Med., liv, p. 5, 6. Footnote 41: Ziegler’s Beiträge, 1903. Footnote 42: Archiv für klin. Chirurgie, p. 1066, 1904. Footnote 43: Sajous: “Internal Secretions, etc.,” vol. ii, 1907. The external appearance of such cases of obesity, which we have described before the French Congress of Medicine in 1904, and the London Pathological Society, February 21, 1905, as endogenous obesity, is also clinically different from the appearance of those caused by overfeeding. As we have shown, persons addicted to rich food, with little exercise, are often red in the face, and are plethoric; they easily become overheated and perspire freely. They seldom complain of constipation. On the other hand persons suffering from endogenous obesity generally look pale, always complain of cold and dry skin, and perspire very seldom, if at all. As a rule they are also very constipated. There is still another ductless gland which influences metabolism in a powerful way. This is the pancreas which, by its three enzymes, brings about the assimilation of the proteid carbohydrate and fatty materials. To these may also be added its production of labferment. By its internal secretion, which is probably produced by the islands of Langerhans, it aids in the oxidation of the sugar, introduced into our alimentary canal in the shape of starchy food, or contained in the carbohydrated radicle of the albuminous molecules, as demonstrated by Pavy. The entire degeneration of the pancreas, especially of the part containing the islands of Langerhans, produces a disease that is, as a rule, characterized by loss of weight and the production of emaciation often to an astonishing degree—i.e., diabetes.