After the thyroid and ovaries we will direct our attention to the pituitary body. Direct examination of this ductless gland being out of question, owing to its position on the base of the skull, in the _sella turcica_, we have to judge of its vitality by indirect methods. We know that by the alterations of this gland a condition is produced, called acromegaly, characterized by enlargement of the toes, fingers and nose, prominence of the lower jaw, sinking in of the temple and of the _fossa canina_ in the cheek-bones, prominence of the occipital bone, etc. As with all diseases of the ductless glands, besides the extreme form just described, which constitutes the highest degree of such a degeneration, there are also marked cases where all of the above deformities are only slightly pronounced. We must inquire whether the features of such persons have changed, or the nose, hands, and feet become larger. This is best determined by comparison of old and recent photographs. A history of headache, especially nocturnal, of mental change, e.g., great susceptibility or symptoms of neurasthenia, taken together with the external appearances, may aid our diagnosis. The simultaneous discovery of an ocular lesion (hemianopsia) will confirm our suspicions beyond doubt. The pancreas, also, can only be examined by indirect evidences of its activity. A history of frequent or occasional epigastric colic, of large quantities of unformed shapeless stools of a yellow or yellow-gray color, containing undigested fat, together with loss of weight, will make us think of the possibility of disease of the pancreas. The most exact proof of such change can only be obtained by microscopical examination of the fæces. Examination of the urine for sugar can also tell us whether there is disease of the pancreas, especially of those parts of the pancreas which constitute a ductless gland, independently of the rest of the viscus, namely, the islands of Langerhans.[125] Footnote 125: Langerhans: Thèse, Berlin, 1869; G. Lange.