The two most constant anatomical changes found in Addison's disease are the pigmented spots consisting of gran ular pigment deposited in the deeper layers of the rete Malpighi and the caseous or tuberculous degeneration of the suprarenal capsules. Of 375 cases collected by Lewin, in 23S the suprar enals were found tuberculous, and in many other cases they were affected with inflammation, cysts, atrophy, carcinoma, or sarcoma.
Case iv which the tubercular nature of the lesions in the suprarenal bodies was demonstrated. Death took place with absolute suddenness. The autopsy showed slight evidence of tuberculosis of the lung. One suprarenal capsule pre sented a very pronounced caseation, and was large and lumpy. In the other the lesion was much less pronounced. The capsule was not greatly enlarged, but its normal tissue had disappeared, and its place was taken by a general, homo geneous, tough tissue, in which were a few caseous centres. Microscopical ex amination demonstrated that the lesion was tubercular, and there were tuber cular bacilli in the capsules. The bacilli were not numerous, but unequivocal. Joseph Coats (Glasgow Med. Jour., Aug., '92).
Five cases of Addison's disease which had been examined, first clinically and afterward post-mortem. In all of them the suprarenal capsules were found dis eased. In four they were extremely tuberculous, three showing the disease on both sides, and one on one side only. In the fifth case there was a carcinoma tous degeneration of the left suprarenal as well as left-sided pulmonary cancer. Posselt (Centralb. f. klin. Med., Feb. 5, '95).
Case of Addison's disease in a boy, 14 years old, suffering from old pulmonary tuberculosis, with recent miliary out break; considerable epigastric pain dur ing life. No pigmentation of skin. Post mortem disclosed, in addition to lung condition, enlarged and pigmented bron chial glands, enlarged and firm mesen teric glands, with congestion of liver, kidneys, spleen, and intestines. Capsules of suprarenal bodies were thickened and adherent to surrounding tissues. Each suprarenal body was four times normal size. On section they were caseous, and contained cretaceous nodules. Micro scopically mesenteric glands showed small-cell infiltration without giant-cells. Periphery of suprarenals was rich in typical small tubercles, many containing large, multinucleated giant-cells. Signs
considered of diagnostic importance were extreme asthenia, emaciation, anorexia, vomiting, abdominal pain, and small, rapid pulse. J. Anderson (Lancet, June 18, '98).
Autopsy of a case of Addison's disease in a girl who had had tuberculous cer vical glands and tuberculosis of the lungs, with brownish skin and extreme anaemia. Both adrenal bodies were found infected with tuberculosis. The object of the adrenal bodies is to absorb certain toxic substances manufactured in the intestines. Huismans (Mtincbener med. Woch., Apr. 2, 1901).
Next in frequency to the suprarenal capsules, the ganglia of the sympathetic system of nerves have been found altered in structure, especially in the neighbor hood of the capsules. In many cases structural changes have been found to co-exist in both the capsules and the ganglia of the sympathetic in the same patients.
On the other hand, a few cases have been reported presenting all the clinical symptoms of Addison's disease, in which the autopsy failed to find any structural changes in either the suprarenal capsules or the nerve-ganglia.
Case in which the typical changes were encountered, and in which there was found a chronic spinal sclerosis of the posterior root-zones, with a neuritis attacking especially the posterior roots of the spinal nerves. Marked by a swell ing, of the axis-cylinders, their rupture at places, and a multiplication of cells. Kallendro and Babes (La Semaine Med., Feb. 22, '89).
[The cases of adrenal involvement without co-existing pigmentary changes lend considerable weight to the asser tions of those pathologists who find Addison's disease rather a disease of nervous origin than one involving a glandular organ. This opinion is further strengthened by the finding of pigment ary changes in cases presenting no demonstrable change in the adrenals. Another point of no slight weight may he taken in the suggestion of Jtirgens, that at least a certain class of pigmented instances are due to peripheral nervous irritation, possibly from epithelial de generation or actual external irritation, mostly met about the flexures, folds, and in the face, from exposure. This last suggestion is further borne out physio logically from the pigmentation often caused by the constant wearing of even non-metallic objects, as buttons, next the skin.