THE SUPRARENAL SYSTEM 163 



Moreover, it must be borne in mind that, though the destruction of 

 the suprarenals means the suppression of a considerable portion 

 of an organic system, the suprarenals form a portion only of that 

 system, the probability being that the adrenal system is not 

 appreciably affected by such suppression. Moreover, consider- 

 able portions of interrenal tissue, which vary in size in individuals, 

 may be present as accessory interrenals. 



A critical survey of the facts which we possess concerning 

 the pathogenesis of Addison's disease leads inevitably to the 

 conclusion that Addison's theory, according to which the clinical 

 complex presented by the condition is the result of an anatomical 

 disease of the suprarenals, explains the large majority of cases, 

 and that the instances in which the functional derangements are 

 not associated with appropriate anatomical findings are excep- 

 tional. But the pathological anatomy of Addison's disease is as 

 yet unable to explain the physiological and pathological signifi- 

 cance of the different parts of the suprarenal system. We are 

 not at present in a position confidently to assert that the 

 suppression of a definite suprarenal system is the cause of the 

 condition, and we are even less justified in forming conclusions 

 upon the homogeneity of the suprarenal function from the 

 pathological-anatomical conditions as seen in man. 



THE SYMPTOMATOLOGY OF ADDISON'S DISEASE. 



Addison's description of the clinical symptoms of chronic 

 .suprarenal derangement is so significant and comprehensive that, 

 though the exhaustive clinical investigation of the last fifty years 

 has strengthened and defined his view, it has added little to the 

 symptomatology of the condition.* 



Experimental pathology has not as yet provided a satisfactory 

 explanation of the genesis of individual symptoms. As we have 

 already pointed out, the destruction of the suprarenals is not 

 followed in animals by a symptom-complex analogous to that seen 

 in man ; such an analogy, as we know, exists in the case of 

 thyroid suppression. The well-defined and characteristic signs of 

 Addison's disease as seen in man are represented in animals by 

 'vague and ill-defined symptoms of acute suprarenal suppression. 

 This difference is most easily accounted for by the radical differ- 



J f' 



ence in the two subjects in the duration of functional suppression. 

 It seems almost as if, in the case of the animal, there was not 

 sufficient time after acute destruction of the suprarenals for the 

 development of symptoms of chronic disease. Owing to the fact 

 that partial destruction of the suprarenals gives rise to regener- 

 ative processes and to the vicarious activity of the sound portion, 



* A comprehensive description of the clinical appearances in diseases 

 of the suprarenals is given in a monograph by Bittorf, and also by v. Neusser 

 and Wiesel. 



