On the other hand, one or more cases have been recorded as occurring as late in life as 70 years.
As predisposing causes, we find enu merated excessive physical labor, men tal anxiety and depression, caries of the spine, confinement in damp and ill-ven tilated rooms, insufficient food, blows upon the abdomen, and tuberculosis of the peritoneum. Greenhow claimed that nine-tenths of the cases collated by him had occurred among the laboring classes. Nearly all the conditions mentioned as predisposing causes are the same as are generally alleged to predispose to pulmo nary and other varieties of tuberculosis. The more efficient or direct cause of the disease under consideration appears to be an interruption of the functions of the suprarenal capsules. According to Lewin, some degree of structural disease of these capsules is found in SS per cent. of all the cases, and the most frequent of these changes is tubercular.
Tuberculosis is the most frequent and important change in the adrenals in Addison's disease. The various other changes in these bodies—as chronic in flammation, caseation, or calcareous infil tration—are to be regarded only as the different results of the tuberculosis. Alezais and Arnaud (Revue de Med., Apr., '91).
Typical case in which the suprarenals w ere both enlarged and cheesy, the ab dominal sympathetics being enlarged and red to the naked eye, associated with pulmonary tuberculosis and Pott's dis ease of the spine. Tyson (Univ. Med. Mag., Sept., '91).
It has been proved that the etiological factors underlying Addison's disease are not dependent upon the presence or ab sence of the adrenals alone. The chief symptoms of Addison's disease can be produced by lesions of ganglia in close association with the adrenal blood supply. A. F. Jonas (Annals of Surg., Apr., '98).
Analysis of several cases tending to suggest that certain toxic substances, such as pyrocatechin, phosphoric and lac tic acids, are developed in the intestines and muscles, and that these are altered in the suprarenals and there prepared for excretion. When for any reason the
suprarenal tissue is destroyed, these sub stances will remain in the system and lead to a chronic intoxication. I. Huis mans (Minch. med. Woch., Mar. 27, 1900).
History of a family in which the mother with her first pregnancy had be gun to pigmentation. With each subsequent pregnancy she had become more pigmented and more depressed, and at the time of the report she had marked disturbance of the gastrointestinal tract, with irregular pains, attacks of giddiness and syncope, and numerous almost black spots resembling moles over the body. Four children showed similar symptoms, decreasing in degree and severity directly with their youth. The cases were dis tinctly Addison's disease, but tuberculo sis might have existed in the whole family and have involved the suprarenal glands. Family involvement in Addison's disease has been rarely noted. R. A. Fleming and J. Miller (Brit. Med. Jour., Apr. 2S, 1900).
Pathology. — The post-mortem exam ination of the case reported by Jonas, in addition to the bronzed spots on the surface, the cavities of the heart moder ately filled with blood only partially co agulated; the liver and spleen of natural size and color; the mucous membrane of the stomach and ileum congested, softened in some places with abrasions; and the suprarenal capsule much en larged. No other morbid appearances were noticed in the abdominal viscera. An incision through the centre of the suprarenal capsules revealed a central caseous mass in each, of the consistence of new cheese, about thirty millimetres in diameter, inclosed in a sac of gray, fibrous tissue, with some spots and streaks of yellowish color. On the sur face of the caseous mass next to the surrounding capsule was a thin layer of a creamy consistence, and the fibrous capsule under the microscope showed the presence of fusiform, lymphoid, and large granular or giant cells in consid able numbers. Both capsules presented the same appearance and were undoubt edly good specimens of tuberculous dis ease.