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Functions of the Adrenals - Addisons Disease and Other

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FUNCTIONS OF THE ADRENALS - ADDISON'S DISEASE AND OTHER Nothing is definitely known as to the functions exercised by these bodies. They are classed with the ductless glands, and commonly believed to form part of the lymph-system of the body. Neither from physiological experimentation nor from pathological investigation has much light been as yet shed upon this subject.

It may be safely affirmed that there was practically no knowledge of any value respecting the diseases of the adrenal bodies till 1855, when Dr. Thomas Addison," of Guy's Hospital, first published his observations on the malady now known by his name. * From that time careful study has been made of the organs, and their grosser diseases are now well recognized. It may further be affirmed that, despite all this knowledge, we still remain in ignorance of the exact functions of these organs in health. We can only surmise that they act most probably as do other ductless glands in the body, and are more particularly a part of the lymphatic system. Without doubt, they bear a remarkable relation to the great abdominal nervous cen tres, not only lying in close anatomical contiguity to these, but bear ing in their intimate textures a larger portion of nervous tissue than is to be found in glands of any kind within the organism.

This latter fact is of prime importance, and can never. be lost sight of while considering the morbid anatomy and the symptomatology of all diseases to which these organs are prone.

It is further to be noted that no morbid condition of the adrenals is capable of affording any detectible physical signs during life. Their size and position almost preclude such a possibility. Their morbid conditions can therefore only be recognized by attention to the clinical symptoms determined by such states, and, as we shall find later on, there may even be no clinical symptoms in some forms of disease of these organs.

Some recent researches by Dr. A. G. Auld, of Glasgow, are of in terest in respect of the functions of the adrenal bodies.' This ob server finds that the blood is almost entirely collected in the inner layer of the cortical zone, and that the cells composing it are more or less pigmented, and highly so in some cases. He finds that many red corpuscles make their way into these cells, and are to be found, by suitable staining, in their interior in all stages of regressive meta morphosis. He believes that certain of these corpuscles are selected

and attracted by a chemiotactic action within the phagocyte cells. They then assume a greenish-brown color and begin to break up into larger and smaller particles. The nucleus of the phagocyte is usually much obscured by the pigmenting particles, but it is large and, to gether with the protoplasm, may show signs of formative activity. Dr. Auld therefore believes that one, at least, of the functions of the adrenals is to destroy a certain class of effete red corpuscles of the blood, and he thinks this is accomplished, possibly, by means of a ferment.

Respecting the medullary portion, he makes out three kinds of cells, namely, (1) glandular columnar or polyhedral cells, faintly eosinophilous, with many large round or oblong nuclei, arranged in the meshes of the reticular stroma ; (2) highly branched corpuscles, non eosinophilous, probably modified nerve-cells; and (3) ganglion cells proper, which cluster round large nerves passing straight through the cortex, and also exist isolated in the reticular meshes. Dr. Auld be lieves it may be a function of the medullary portion to test the qual ity of the blood, purified by filtration through the cortex, ere it enters the circulation, and he believes moreover that it may also aid in further reducing effete substances. Examination of the blood after passing through the medulla shows that it has the characters of ar terial, oxygenated blood, as it flows through the adrenal veins.

Dr. Auld therefore regards the supra-renal bodies as in part ex cretory or depuratory glands, and he regards the symptoms of Addi son's disease as due to interference with these functions, leading to the circulation of decomposing products of hemoglobin and a ten dency to pigmentary deposition. * He finds that the cells of the outer cortical zone (zona glomerulosa) are moderately eosinophilous, unlike those in the columns of the mid dle zone, and that they readily absorb logwood stain. He notes the existence of a central lumen in these columns, filled with secretion, which he thinks is carried away by the lymphatics to minister to cer tain needs of the organism. The appearance in this outer zone much resembles that found in the anterior lobe of the pituitary body.

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