VARIATIONS IN ADRENAL FUNCTIONAL ACTIVITY. 21 



dent signs of organization, at times indicating a local inter- 

 stitial inflammatory process, at others a retrogressive meta- 

 morphosis recalling that observed in hgematomata. Finally, 

 using his words: "The normal anatomical elements of the 

 suprarenal gland may be found in a more or less perfect state 

 of integrity, either in the periphery of the growth or at one 

 of its extremities." 



This not only typifies the gradual progress of disease in 

 the medullary substance and the steady and certain submission 

 of its structure to the destructive agency, but it also indicates 

 if we recall the fact that mammals continue to live,, as shown 

 by Gourfein, when over nine-tenths of either of their adrenals 

 that is to say, nineteen-twentieths of both has been removed 

 that, unless some compensative action or some accessory 

 organ be present, death occurs when this limit of normal ad- 

 renal substance is reached. This is well shown in Andrewes's 

 case, previously alluded to, in which a small strip of normal 

 substance was found post-mortem in the adrenals, the only 

 organs of the body presenting any indication of disease. Again, 

 it becomes evident that Nature supplies mammals with twenty 

 times the amount of medullary substance required under nor- 

 mal circumstances: a proportion probably far exceeded in man, 

 as a result of development incident upon his varied diet. Were 

 the medulla itself capable of 'assuming compensatory activity, 

 so large a supply for emergencies (the nature of which will be 

 described later on) would hardly have been provided. If 

 analogy be again accepted as guide, other organs do not com- 

 pensate for what insufficiency organic disease may produce in 

 them by overtaxing remaining normal structures; collateral 

 kindred tissues, supernumerary or accessory organs, vicarious 

 functions, and hypertrophy being all added elements, thus con- 

 stituting either auxiliary resources per se or auxiliary resources 

 plus compensative growth. Even in the case of the organs 

 of special sense, where the loss of one organ imposes all the 

 physiological labor upon the other, the existing tissues are not 

 overtaxed; they are brought to their highest proficiency by the 

 increase of nutrition which the additional functional use in- 

 volves. Whatever evidence we have, therefore, tends to show 

 that the remaining normal structures of a diseased adrenal do 



