The opposite view—i.e., of glandular destruction — cannot, however, be set aside, numerous careful observations and the results of various experimenters offer ing weight in this direction.
As to the nature of growth found in the suprarenals, there can be but little doubt that other new formations than tuberculosis are attended by the com plex of symptoms of Addison's disease. TYSON and SMITH, Assoc. Eds., Annual, '89.1 Investigations upon rabbits and dogs showing that the adrenals stand in inti mate relation with the central nervous system, and that their affection is the cause of the train of phenomena known as Addison's disease. Tizzoni (London Med. Recorder, Feb., '90).
Case in which, associated with the ordinary symptoms, there occurred a sudden attack of bromidrosis, indicating a rather serious involvement of the sympathetic nervous system. Ohmann Dumesnil (Atlanta Med. and Surg. Jour., July, '90).
Six cases of adrenal caseation, in some of which there was distinct round-celled infiltration of the semilunar ganglia without bronzing of the skin. Addison's disease cannot be said to be directly due to changes in the sympathetic abdominal ganglia, although, perhaps, this or that symptom of the affection may depend on such involvement of the sympathetic ganglia. Von Kahlden (Munch. med. Woch., June 23, '91).
Not the great sympathetic nerves and ganglia, not the suprarenal capsules themselves, but the pericapsular nerve ganglia constitute the especial starting point for the development of the symp toms of Addison's disease. Alezais and Arnaud (La Semaine Med., Oct. 7, '91).
Four autopsies suggesting that the dis ease is due to irritation of the abdominal sympathetic from direct lesion of the nerve, its ganglia, or the suprarenal cap sules. This lesion is most frequently primary or secondary to tuberculosis of the capsules with secondary involvement of the sympathetic. In less than 20 per cent. it is not tuberculous, and in 12 per cent. of the cases the capsules remain normal. Thompson (Amer. Jour. of the Med. Sciences, Oct., '93).
To be regarded as a functional whole, the cortex and the medulla doing the same work, but in unequal degrees. Atrophy of the suprarenal capsules oc curs normally in old age, but may occur earlier in life and cause Addison's dis ease. Hemorrhage into the substance of the gland may be due to traumatism either later in life or in infants at birth.
Fatty and lardaceous degenerations oc cur. The glands have been found to contain cysts. Out of one hundred and thirty-one cases in which death was due to tuberculosis, the glands were tuber culous in eighteen, without, however, there being any signs of Addison's dis ease. Rolleston (Lancet, Mar. 23, '95).
The primary morbid conditions or processes on which depend the develop ment of the clinical phenomena of Ad dison's disease have not yet been so clearly demonstrated as to remove the subject from the fields of controversy or doubt.
Much the larger number of writers incline to agree with Dr. Addison, who ascribed all the essential symptoms and results of the disease to interruption of the function of the suprarenal capsules caused by some form of disease in those organs. Those holding this view assume that these bodies either destroy some toxic element resulting from natural metabolic changes in the blood or tis sues, or secrete and return to the blood some substance necessary for the main tenance of health.
Pyrocatechin, found in the medulla of the suprarenal gland, becomes brown in contact with air or alkaline tissues. It is converted in Addison's disease into a poisonous compound on leaving the su prarenal body and entering the circu lation. In health the elimination of pyrocatechin occurs through the agency of the sympathetic ganglion-cells. The debility, etc., are the signs of chronic poisoning with pyrocatechin: an auto toxication. Millihnann (Mtinchener med. Woch., Feb. 16, '96).
Certain changes in the suprarenal cap sules—such as hyperemia, hypertrophy, etc.—are noted when certain poisons are introduced into the system, especially if slowly given: cloves, toluene-amin, tox ins of bacilli, etc. (Roux and Yersin, Roger, Pi]liet, Charrin and Langlois.) The toxic power of the extract of suprarenal capsules was noted by Fott and Pellacani (1334), and has been ex amined since then by many authors. It causes a rise in the blood-pressure com bined with slowing of the heart. (Cy bulski, Olivier and Schafer.) Capsules which are affected with hyperemia still contain the principle which gives rise to the above effect (not pyrocatechin); but capsules hypertro phied to double or more their original size no longer contain it. P. Langlois (Arch. de Phys., vol. viii, p. 152, '96).