OTHER PATHOLOGICAL ABNORMALITIES 365 



tions of the burned area is the prime cause of a fatal outcome. 

 In view of the demonstrable lesions in the adrenals, it would 

 seem worth while to investigate the therapeutic effects of the 

 adrenal cortical hormone in these cases. 



INFECTIONS 



In acute bacterial toxemias, focal necroses are often ob- 

 served in the zona fasciculata which resemble those occurring 

 in the spleen and other viscera. Regeneration may occur in 

 these areas as noted by mitotic activity. Cloudy swelling 

 and edema of the adrenals also occur and are most prominent in 

 the inner cortical zone. Such edema is common in patients 

 dying of acute infections. Congestion and small focal hemor- 

 rhages are also frequently found and there is a disappearance of 

 the cholesterol bodies from the cortex. 157 



Changes in the adrenals, of the nature described above, 

 were observed by Klotz in 14 of 32 patients dying of influenza. 132 

 Paisseau and Lemaire described similar changes in pernicious 

 malaria and others have found them in diphtheria, broncho- 

 pneumonia and other toxemias of bacterial origin. 417 



One might anticipate that bacterial toxins will affect the 

 adrenals as they do other parenchymatous glands. The 

 questions of prime importance are: Does this injury to the 

 adrenal cortex as observed pathologically contribute to the 

 clinical symptoms of these diseases? Are the epigastric pain, 

 the vomiting, asthenia, hypothermia, and hypotension due to 

 an acute cortical insufficiency induced by the disease? It is 

 impossible to answer these questions at present. Clinical 

 investigation of the effects of therapy with the adrenal cortical 

 hormone is obviously necessary for elucidation of the problem. 



The symptoms of the nitroid crises following injections of 

 arsphenamine and preventive vaccination have also been 

 attributed to adrenal hypofunction. However, the nature of 

 these symptoms and their acute onset speaks against an adrenal 

 involvement. 



