EFFECTS OF REMOVAL SIMILAR IN ALL VERTEBRATES. 5 



suprarenals is followed by death, and that these organs fulfill 

 in the organism a role of great physiological importance. 



Are the suprarenal glands functionally as important in 

 man as they are in the lower vertebrates? The clinical field 

 alone offers the necessary elements for the study of this ques- 

 tion; but it is strewn with obstacles. The various kinds of 

 neoplasms which develop in these organs, with the possible 

 exception of sarcoma, are of slow growth; the sufferer passes 

 through various phases that are more or less influenced by 

 concomitant conditions and by the pressure which the tumor 

 exerts upon important neighboring structures. In carcinoma 

 there may also be involvement of other viscera by continuity 

 of tissue or metastasis. We therefore obtain, in relation to the 

 symptom-complex of pure suprarenal origin, a transformed 

 picture, one that precludes all certainty as to the relations 

 between cause and effect. Addison's disease affords, if any- 

 thing, less opportunity for solid analysis; it may be associated 

 with suprarenal lesions and it may not; in some cases but one 

 organ is involved; in others, both; if it is due to suprarenal 

 tuberculosis, this process may be secondary or primary, thus 

 furnishing a series of misleading symptoms due to the extrinsic 

 lesions; finally, we may at a post-mortem find the organs com- 

 pletely destroyed and obtain an ante-mortem history in which 

 the Addisonian syndrome is conspicuously absent. 



What is required for a fruitful analysis of this question is 

 a condition in which the adrenals are alone the seat of a mortal 

 lesion: a lesion capable of suddenly annihilating the functions 

 of both organs precisely as does their experimental removal 

 in animals. A single disorder of the adrenals, among the few 

 that have been so far described, fulfills these requirements in 

 some of its manifestations, namely: haemorrhage. The litera- 

 ture of this subject is, however, exceedingly meager: hardly 

 one hundred cases having been reported. We are therefore 

 fortunate in having at our disposal an able and exhaustive re- 

 view of eighty of these cases, including several of his own, by 

 Frangois Arnaud, 14 of Marseilles, which afford the necessary 

 data. While some of the cases are very briefly reviewed, the 



Frangois Arnaud: Archives Generates de Medecine, p. 64, July, 1900. 



