358 CLINICAL CONSIDERATIONS 



As noted by Zander, 696 the ganglia of the sympathetic system 

 are fully developed in cases of hemicephaly. In spina-bifida 

 and in hydrocephalus, no abnormality of the adrenals is noted. 



STATUS LYMPHATICUS 



The adrenal cortex is often hypoplastic in cases of so-called 

 "status lymphaticus." 230 In adrenal insufficiency, conversely, 

 there is often hyperplasia of the thymus and other lymphoid 

 tissue. 335 Unfortunately, our ignorance of the exact function 

 of the thymus and lymphatic system renders any discussion 

 of the probable significance of this adrenal-lymphatic relation- 

 ship futile. The lymphatic system responds by hypertrophy 

 or atrophy to so many clinical conditions that it is unjustifiable 

 to attribute any more fundamental relation between the ad- 

 renals and the lymphoid tissue than exists between the latter 

 and the thyroid, for example. As regards the relation of the 

 adrenals to status lymphaticus, there is no longer a tendency 

 to regard this condition as a disease entity. As Groll 157 

 showed, the hyperplasia of the thymus and other lymphoid 

 tissues which characterize status lymphaticus were frequently 

 observed in healthy normal individuals killed during the Great 

 War. It would, therefore, be too far-fetched to attribute the 

 sudden deaths, presumably due to a questionable pathological 

 condition (status lymphaticus), to an acute adrenal insuf- 

 ficiency. 



Instances of sudden death following a prolonged exposure 

 to heat, narcosis, muscular exertion, or certain poisons have 

 also been attributed to an acute adrenal insufficiency. Au- 

 topsy in such cases has revealed a marked decrease in the 

 epinephrine content of the medulla and vacuolar degenerative 

 changes in the cortex with no changes in other organs to 

 account for the sudden death. Since the influences cited 

 above are accompanied by an increased utilization of the 

 cortical hormone, it is not irrational to assume that they 

 might by exhausting the supply of the hormone in the body 



