20 THE PHYSIOLOGY OF THE ADRENALS. 



the result of the impairment by the toxic elements of the 

 functional activity of the organs? If the increase of blood is 

 primary, we would have over activity ; if the toxics first paralyze 

 the glandular tissues and haemorrhage occurs as a result, we 

 would have insufficiency. 



This question may perhaps be elucidated by tracing to 

 their origin, the symptoms that appear in various cases in 

 which the haemorrhage occurs as a complication of local chronic 

 disease. These at first seem to afford a ready answer, since the 

 vast majority of them are traceable to organic lesions of the 

 glands that practically annul their efficiency by destroying the 

 greater part of their substance. Partial destruction of the 

 organs and corresponding loss of activity follow each other so 

 logically that any conclusion other than that hemorrhage oc- 

 curs as a result of glandular insufficiency seems unwarranted. 

 And yet the opposite might be true, since partial organic de- 

 struction of the organs might cause their physiological func- 

 tions to become concentrated upon what normal structures are 

 left. Both arguments are equally strong, therefore, and fur- 

 nish but little light. Yet they afford a clue by suggesting the 

 question: Can the normal suprarenal substance left assume the 

 additional functional power represented by that lost through 

 destruction of a part of the organ? 



While studying the pathological histology of suprarenal 

 haemorrhage, Arnaud found that it was not in the medulla 

 proper, as generally believed, that these haemorrhages occurred, 

 but in the tissues of the internal cortical zone. In emphasizing 

 this fact, he states: "It is at this point that the capillaries tear 

 under the influence of a powerful congestion. When the 

 haemorrhage is important, it is due to rupture of one of the 

 branches of the capsular vein at any point of its walls, and 

 occurs into the medullary substance or into the central con- 

 junctivo-vascular sheath." The medulla proper is thus re- 

 spected to the last, either a capillary peripheral to it, or some 

 part of the intrinsic portion of the vein probably weakened 

 liy the local disease constituting the yielding structure. 

 Furthermore, Nature seems to protect the last vestiges of the 

 medullary substance even after a localized haemorrhage. This 

 is suggested by the fact that Arnaud found in such areas evi- 



