Í53 



«hetes in the infilti'ated sites. Two years 

 later, in 1918, he (3) returned to the sub- 

 ject, publishing an original article, under 

 the title of «The new pathology of syphi- 

 lis», with a page on the adrenals, the 

 lesions of which he described with more 

 detail illustrating them with a micropho- 

 tograph in support of his previcius 

 views. 



Identical observations had already 

 been previously made not only by 

 FORDYCE (4) who observe that all lym- 

 phatic lesions begin in the perivascular 

 lymphatic spaces as infiltrations of lym- 

 phocytes and of plasma-cells, but also 

 by VAN GIERKE who describes a case 

 of infiltration of the medulla with peri- 

 vascular infiltration, pronounced altera- 

 tion of the cortex and inflammatory 

 process of the capsule. 



My own observations, which follow, 

 were carried out in the Department for 

 Pathological Anatomy of the Institute 

 Oswaldo Cruz. 



They refer to 90 autopsies on syphi- 

 litic subjects, whose diagnosis had been 

 made not only by macroscopical but also 

 by histological methods. Out of this 

 number 75 shov/ed adrenal lesions, spe- 

 cific in the acceptation of all the authors. 

 The lesions found were as follows. 



I) Infiltrations of limphocytes and 

 plasma-cells 63 o/o, mostly perivascular, 

 inside or outside the capsule, or less 

 often in the corte.x or dispersed in the 

 organ. 



II) Thickening of the capsule 31 o/o, 

 with pericapsular infiltrations. 



(^ — The American Journal of Syphilis, 1918. 



(4^ — Fordyce, Aiiier.'Journ. of Med. Sciences, v. 149, 



3915. 



Ill) Limited fibroses 3,3o/û (see note 

 X). 



We did not observe any cases of 

 calcified gummata with giant-cells, atro- 

 phy of the capsule or simple prolifera- 

 tion of the fibroblasts, these the lite- 

 rature as rare. We were, however able 

 to confirm SCOTT's observation of spi- 

 rochetes in the zones of diffuse infiltra- 

 tion of lymphocytes as will be seen in 

 Figs. 10 and 11 (from autopsy 1457, as 

 also 5 and 6) reproducmg, impregnated 

 by LEVADITI's process, sections from 

 one of the adrenals with the most exten- 

 sive lesions. 



As we could not dispose of clini- 

 cal observations on the cases submitted 

 to us for anatomo-pathological investiga- 

 tion we were unable to estaJ^lish the 

 connection belweed the lesions found and 

 the clinical symptoms that might have 

 ► been observed. 



It is certain thai in lesions of ani kind 

 localised in the adrenals (Addison s di- 

 sease), extensive bilateral lesions are very 

 imcommon, and only rarely make then- 

 selves felt by clinical symptoms. The 

 cases found in the littérature on the 

 subject reporting cures by specific anti- 

 syphilitic treatment are even more mi- 

 common. And yet, according to my opi- 

 nion, the histological verification of the 

 lesions of syphilitic origin in the adre- 

 nals is not meely oí anatomical interest 

 but is also a valuable element for the 

 pathological diagnosis of the di- 

 siase since it is by itself sufficient to 



(x)— Besides the above mentioned syphiht'c lesions 

 I observed 20 capsules with adenomata, 19 with lipoido. 

 sis of the cortex 1 with tuberculosis 1 with malign tu- 

 mour, 2 with haemorrhage, 11 with hyperaemia. 



(x)— Virchow's Archiv. B. 172, 1903. 



Beitrâge zur Patholog. Anatomic und zur Allg. Pa- 

 hologie Bd. 62, 1916. 



Annales de Dermat. et de Syphiligraphie, 19Ü5, 638, 

 212. 



Annales des Maladies Vénériennes, 1911, 320, 



Gazette des Ho. 1317, 1914. 



New York Medical Journal 1916. 



