8 THE PHYSIOLOGY OP THE ADRENALS. 



report was published almost two years after the operation. A 

 fibromyxosarcomatous adrenal was removed, along with the 

 entire right kidney, by Howard A. Kelly. 25 The case proceeded 

 to full recovery notwithstanding the malignant nature of the 

 growth. A tuberculous adrenal and the right kidney were also 

 removed by A. F. Jonas. 26 The patient was discharged six 

 weeks later in full convalescence. Finally, Knowsley Thorn- 

 ton 27 removed a sarcomatous gland from a woman aged 56 

 years. The patient was seen six years later and found in good 

 health. 



This does not mean, however, that a diseased gland may 

 not cause death. In this particular the adrenals are similar 

 to any other organ. A rapidly growing sarcoma or a carcinoma 

 may start in one of the organs, develop by metastasis elsewhere, 

 and cause death. Tuberculosis frequently finds a nidus in 

 either adrenal or both simultaneously; this process, along with 

 the asthenia engendered by the suprarenal disease, may rapidly 

 end in death. Again, when we consider the frequency with 

 which fatty degeneration is found in these organs when micro- 

 scopically examined, thirty-six times out of one hundred 

 autopsies taken at random, according to Arnaud, 28 it would 

 certainly be unwise to establish such limits. 



But this also suggests that death may thus follow any 

 destructive process (haemorrhage included) of a single adrenal, 

 if the functions of its mate are sufficiently inhibited through 

 a local lesion or by a morbid condition involving its peripheral 

 vascular or nervous supply. Indeed, the anatomical relations 

 of these glands indicate that their functions are primarily de- 

 pendent upon the integrity of these trophic structures. The 

 multitude of nerves distributed to them include medullated 

 fibers from the solar plexus, the sympathetic's densest net- 

 work. Dogiel 29 states that the internal zone of the cortex is 

 surrounded -by a more or less dense fibrillary plexus, and that 

 the medullary substance is supplied with an extraordinary sup- 



28 Howard A. Kelly: Quoted by Ramsay, Johns Hopkins Hosp. Bull., Jan., 

 Feb., Mar., 1899. 



26 A. F. Jonas: Annals of Surgery, April, 1898. 



27 Knowsley Thornton: Harveian Lectures. 



28 Arnaud: Loc. cit., p. 6. 



29 Dogiel: Archiv f. Anatomie u. Physiologie, p. 90, 1894. 



