HYPEFLEMIA AND EEMORRLLAGE OF TFIE SLTRAP,ENAL GLANDS In the newborn, the suprarenal blood supply is normally very rich. This fact explains its very pronounced tendency to passive hypertemia in all those diseases which are attended by general congestion; in all infectious diseases 113-pen-culla is very active. It has been long recog nized that the experimental infection of guinea-pigs with diphtheria would result in hyperwmia of the suprarenals, with hxmorrhagic infarc tion, a condition which we sometimes find also at the necropsy of children who have died of diphtheria. Hgmorrhages of the supra renal glands (suprarenal apoplexy) are not rare in the newborn. They may be unilateral or bilateral. The suprarenal gland often attains the size of a hen's egg, and its parenchyma often appears to be com pletely destroyed. These conditions are shown in the colored illus trations of Plates 56 and 57.
In this case, that of a newborn boy, both suprarenal glands were changed into hmmatomata of the size of a pigeon's egg. The autopsy showed also a fracture of the left humerus, a separation of the cartilages from the second to the fifth ribs and a limmorrhagic infiltration of the left sternomastoid, and also of the neighboring fatty tissue.
The conditions in this case illustrate one of the causes of apoplexy of the suprarenal glands, i.e., trauma resulting from obstetric manipu lations in difficult delivery, or in reviving asphyxiated children. But still another series of circumstances may be responsible for the formation of hgmatoma of the suprarenal glands some of which may affect, not only the newborn, but older children as well. Such are compression of
the inferior vena cava between the liver and the vertebral column, caused by strong contraction of the uterus, by which the infantile abdc men is influenced; compression of the umbilical cord during delivery; acute degeneration of the vessel w alls; degeneration of the tissue of the suprarenal glands; convulsions: syphilis: vasomotor disturbances in cerebral diseases; thrombosis of the renal veins and the inferior vena cava; infections. Hamill is of the opinion that Inernorrhage of the suprarenal glands occurring before birth is generally caused by the act of delivery; and that those luemorrhages which occur post partum are as a rule the result of infection spreading from the remains of the umbilical cord.
The etiology of some of the reported cases, especially of those oc curring in older children is very obscure. The case of a child who suffered from purpura luemorrhagica, and died of suprarenal Illemor rhage seems to be of decided interest.
The diagnosis can seldom be established except at the autopsy, since the children generally die of collapse; less frequently after several days, with symptoms resembling, peritonitis. Addison's complex of symptoms is not often observed, evidently because of the brief duration of the disease. Dissections often show the presence of free hwmorrhage into the abdominal cavity.