GENERAL DISEASES. 363 



Humiliation. Various changes in the nerve cells of the semilunar ganglia 

 Save "been described. 



There may be fatty degeneration of the heart muscle and hyperplasia 

 of the Inj-pRtjiial lymph-nodnlfin and splwn 



The Adrenals. The most common lesion of these bodies is a Inbercn- 

 Ions inflammation, and this or "some other lesion has been found in nearly 

 one-half of the cases. On the other hand, it should be remembered that 

 similar lesions of the adrenals often occur without other indications of 

 Addison's disease. Tuberculous adrenals may h^ la,r^e. hard T and nodu- 

 lar ; less frequently of normal size or smaller than normal. On section 

 they may contain cheesy masses surrounded by zones of gray, seinitrans- 

 luceut tissue. Later the cheesy masses may become ^alcified or they may 

 soften and break down. The grayish zones are composed of tubercle 

 tissue or denser connective tissue." 1 



Other cases have been described in which the adrenals were the seat 

 of carcinoma or of fatty or waxy degeneration. But these lesions, espe-~ 

 cially carcinoma of the adrenals, may occur without tlie_ manifestations 

 of Addison's disease. The adrenals in some cases appear normal or they 

 may be atrophied. 



On the whole the clinical, morphological, and experimental data now 

 available seem to point to lesions of both the 



the adrenals as of probable significance in determining this disease. 



The hypothesis which is most in favor at present assumes that the 

 adrenals furnish an internal secretion without which normal metabolism 

 cannot be effected, and that lesions of the adrenals or of the sympathetic 

 ganglia and vessels about them, by altering or diminishing this secretion, 

 may lead to the functional and structural changes characterizing the 

 disease. The propriety of considering Addison's disease as an example 

 of auto-intoxication can hardly be decided in the light of the facts yet at 

 our command. It is clear, however, that the adrenals contain very pow- 

 erful chemical substances which have a marked effect upon certain tissues 

 of the body. 2 



DIABETES MELLITUS. 



This disease involves such defects in nutrition as lead to an abnormal 

 accumulation of sugar in the blood and its discharge by the urine (glyco- 

 suria), which is increased in amount. 



A great variety of lesions have been found in the body after death 

 from diabetes, but few r of them appear to be of well-defined significance 

 in this special relationship. The general condition of malnutrition and 

 debility, so often marked in this disease, renders diabetics especially 



1 For a studj r of experimental tuberculosis of the adrenals and its relations to Addi- 

 son's Disease, see VeccM, Centralbl. f. Path., July 15th, 1901. 



2 For a summary of observations on the effects of removal of suprarenal body and 

 the nature of its "'active principle," consult Abel, "Vaughan Anniversary Contribu- 

 tions to Medical Research," 1903, p. 139; .bibl. 



