420 INANITION AND MALNUTRITION 



In the infant, Beneke ('94) remarked that "zart gebaute schwachliche 

 Kinder haben schmale, fettlose Nebennieren; kraftige, guternahrte dagegen 

 fetthaltige." In athreptic infants, Thiercelin ('04) described hemorrhages as 

 characteristic in the suprarenal glands, sometimes causing a considerable 

 increase in volume. He cited a case observed by Parrot in which the suprarenal 

 was ruptured by distension due to hemorrhage. 



In infantile marasmus, Thompson ('07) noted incidentally that the supra- 

 renal cortex appeared normal; the medulla small in size, with cells swollen or 

 in places replaced by connective tissue. 



Lucien ('08, '08a) found the weight of the suprarenals in athreptic infants 

 greatly reduced, a minimum of 1.05 g. being noted. The color is darker than 

 normal, and the consistence firm. Stained sections (fixation in formalin or 

 Flemming's fluid) reveal various changes. There is a slight thickening of the 

 fibrous capsule and trabeculae, with a sclerosis of the cortex, especially in the 

 reticular zone, and to a less extent in the medulla. The cortical cells become 

 atrophic, especially in the reticular zone, and lose their lipoidal content (except 

 in the most external part of the zona fasciculata). The blood capillaries in 

 the zona reticularis are distended, and a few pigmented cells occur. The 

 changes resemble those described by Bernard and Bigart in tuberculosis, and 

 indicate a hyposecretory condition of the suprarenals, associated with a 

 profound intoxication of the organism. 



Helmholz ('09) in the suprarenals of atrophic infants noted merely a thinning 

 of the cortex with a slight increase in the connective tissue. 



Mattei ('14) gave individual weights for the suprarenals in 7 athreptic 

 infants, and made a careful histological study. The suprarenal weight was 

 usually below normal (assumed as 3 g.), the ratio to body weight being 1 : 1,400 

 to 1 : 2,000 (normal 1 : 750). Mulon's method shows a reduction in the amount 

 of fat in the cortical cells. Otherwise the glomerular and fasciculate zones in 

 general are but slightly changed, although some cords appear swollen and 

 clear, and others present cells and nuclei in various stages of atrophic degenera- 

 tion. In the zona reticularis the blood vessels appear enormously distended, 

 and sometimes ruptured, with scattered atrophic parenchyma in the hemor- 

 rhagic effusion. In the medulla there likewise appears a marked congestion, 

 and also a notable increase in the connective tissue. The chromaffin cells 

 are in clumps or islets, some normal in structure and staining reactions, others 

 swollen or atrophic, presenting various stages of degeneration, sometimes con- 

 taining hematogenous pigment. "Telles sont les alterations glandulaires 

 surrenales les plus ordinaires au cours de nos observations. II est utile et 

 interessant de remarquer que les lesions predominent d'une facon tres nette 

 dans la medullaire et dans quelques boyaux cellulaires de la reticulee." 



Lesage and Cleret ('14) found sclerosis as the characteristic change in most 

 of the organs in congenital spasmodic atrophy of nurslings; but the suprarenals 

 appeared normal in structure. Nobecourt ('16) reviewed the previous work 

 on the changes in the various organs, including the suprarenals, in atrophic 

 infants. 



