266 CORTEX 



ing the body fat in general. The cachexia of cancer or dia- 

 betes, though depleting the store of fat from the body, leave 

 unchanged the lipid of the adrenal cortex. Pathological intoxi- 

 cations, such as diphtheria, increase the apparent fat in the 

 heart and kidney while they exhaust the cortical lipids. The 

 cortical lipid may be unchanged in conditions in which the 

 epinephrine store of the medulla is depleted. The greatest 

 loss of epinephrine from the adrenals was observed by Elliott 

 in cases of afebrile acute cardiac failure. 



The world-war afforded an opportunity of studying the his- 

 tological appearance of the adrenals of individuals suddenly 

 killed in the prime of health and comparing the results with 

 those observed in their comrades dying of various toxic or in- 

 fectious processes. In this way Dietrich 156 obtained consistent 

 data on the changes in the adrenals as a result of wound infec- 

 tions. In no case of death following these infections were 

 changes in the adrenal cortex not present. These changes 

 varied in intensity from a simple disappearance of the lipid to 

 an actual disintegration of the normal cell structure, or con- 

 sisted simply of circulatory changes such as hyperaemia, hemor- 

 rhages, infiltration of leucocytes, or thrombosis. These 

 changes in the adrenals were found in all cases of wound infec- 

 tions whereas there was only an occasional appearance of simi- 

 lar inflammatory changes in other organs. The morbid 

 changes of the adrenal constituted the first and most pro- 

 nounced findings observed at autopsy. The adrenals were 

 most markedly affected in infections marked by a particularly 

 toxic nature such as in the edema of gas poisoning or in peri- 

 tonitis. Although the observed changes were not specific for 

 any particular disease, they were related to the intensity and 

 nature of the infectious process. 376 Injury of the adrenals fol- 

 lowing the toxic and infectious agencies just described is 

 limited chiefly to the cortical cells. The cells of the medulla 

 undergo relatively slight changes as compared to the cortex. 

 Prolonged injury results in the production of "colloid-droplets" 



