Results of experiments on one hun dred and nine rats from which both suprarenal capsules were removed, and others in which these bodies were cauter ized or otherwise inflamed. After the lapse of a few months a large number of these animals showed an infiltration of the pigment in the subcutaneous cellular tissues, in the lumbar and mesenteric glands, in the peritoneum, mesentery, liver, spleen, and lungs. Muscular pare sis had developed in some of them with increasing asthenia; and the injection of an extract from the muscles of such rats proved fatal to other rats. Boinet (La Semaine Mad., No. 8, '96).
This view of the functions of the cap sules, in connection with the fact that some form of disease has been found in them in nearly 90 per cent. of all the cases on record, certainly points directly to interference with OT interruption of such functions as the first link in the chain of pathological processes consti tuting the disease under consideration.
Another class of writers and investi gators, however, finding evidence of structural changes in a considerable number of cases of Addison's disease in the ganglia of some parts of the abdomi nal sympathetic system of nerves, have claimed that these changes are the pri mary pathological steps, and that all the general phenomena result from trophic influences. Prominent among those ad vocating this view are Riesel, Burgen, and W. G. Thompson, while Alezais and Arnaud claim that the primary seat is neither in the ganglia of the sympathetic nerves nor in the suprarenal capsules proper, but in the pericapsular nerve ganglia themselves.
Case in which there was a sudden and maniacal attack the day before death, lasting several hours, dissections show ing caseous suprarenal bodies and the thickening and matting of the tissues in the neighborhood of the semilunar gan glia and solar plexuses. Lindsay Steven (Lancet, Oct. 31, '96).
Certain vasodilator fibres run in the splanchnic nerves to the adrenals. In the dog the splanchnies, after traversing the diaphragm, give off on each side, before they enter into the formation of the solar plexus, a single large branch to the adrenals; these are thought to con tain the chief vasodilator fibres, since, if divided, stimulation of the splanchnics in the thorax is without influence, while stimulation of the distal extremities of the divided nerves is followed by active hyperemia. Arthur Biedl (Pfltiger's Archiv, June, '97).
The theories of the changes in the great sympathetic system and of insuffi ciency of the capsules which have been opposed to one another as an explana tion of the cause of Addison's disease each contain some truth, but are too ex clusive. Where the capsules are either
absent or not diseased, only the nervous theory can be upheld. Clinical research and experiments prove that pathological or experimental destruction of the cap sules acts not only by the ascending and secondary degeneration of the great sym pathetic and its ganglia, but also by capsular insufficiency.
This suppression of the action of the capsules favors retention in the blood, viscera, and muscles of toxic products which appear to play a certain part either in the formation of pigment in the blood or in the production and in crease of the asthenia. E. Iloinet (Revue de Mad., Feb., '97).
In this connection it is proper to state that F. Marino-Zucco, Director of the Chemico-Pharmacentical Institute of Genoa, has obtained neurin from the normal suprarenal capsules in notable quantity, and has detected the same sub stance in the urine of a patient with Addison's disease. This, with further experiments with neurin, led him to re gard the retention of this substance, on account of disease of the capsules, as the probable cause of the more general dis order. The results of the more recent active investigations concerning the functions of the thyroid and other duct less glands, and the therapeutic effects of extracts derived from them, add to the probability that the statement we have quoted from Auld will be found correct. That the suprarenal capsules contain true glandular structure, and also an abundance of nerve-ganglia and filaments connecting freely with the ab dominal sympathetic system of nerves, was fully demonstrated by Henle and von BrUIlll.
The existence of a true glandular structure plainly implies a secreting or transforming function, the suspension of which would lead to some kind of me tabolic disorder, while the close nervous connection with the sympathetic would explain the coincident gastrointestinal disorders and progressive asthenia. This pathological view also enables us to see why the clinical phenomena constituting Addison's disease may be developed, not exclusively by tuberculosis or any one special disease, but by any and every morbid condition capable of persistently interrupting the natural function of the suprarenal bodies.