22 THE PHYSIOLOGY OF THE ADRENALS. 



not assume the physiological functions of the areas destroyed, 

 and it seems clear that the first line of argument i.e., that 

 haemorrhage is the result of glandular insufficiency should 

 prevail. 



Further analysis of this question elicits the fact that the 

 symptoms which characterize the progress of the primary or- 

 ganic disease of the adrenals differ totally from those attending 

 the haemorrhage proper. While the former may hardly cause 

 suffering or be totally obscured by the signs of any concomitant 

 disorder present, the symptoms attending haemorrhage are par- 

 ticularly violent and sudden, the patient abruptly screaming 

 from excruciatingly intense pain in the abdomen, or dropping 

 at once into apoplectiform coma from which he never rallies. 

 Cerebral apoplexy does not furnish a more vivid picture of the 

 overwhelming effects of haemorrhage. Yet haemorrhagic foci 

 in various stages of organization are found at autopsies. Thus, 

 one of Arnaud's cases suddenly fell into apoplectiform coma, 

 and died in 48 hours; the only organs found diseased after 

 death were the adrenals, which contained old haematomata, 

 and various more or less organized haemorrhagic foci which 

 showed that local haemorrhages into them had repeatedly oc- 

 curred. The suprarenal substance was entirely destroyed ex- 

 cepting a narrow zone toward the inferior edge of the right 

 organ. The urine, during life, and the kidneys, after death, 

 were found normal. Obviously we cannot well ascribe the 

 acute symptoms to the primary organic lesion, since they appear 

 suddenly, practically without warning, and promptly lead to a 

 fatal issue. Must we, therefore, as in cerebral apoplexy, ascribe 

 them to the haemorrhage per se? Evidently not, since, as we 

 have seen, haemorrhagic foci of old standing have frequently 

 been found in the organs post-mortem, while the acute. symp- 

 toms had only appeared when death was near. The following 

 conclusions, therefore, seem to conciliate all the data at 

 hand: 



1. The acute symptoms and death which follow hcemorrhage 

 into the adrenals are due to the sudden and complete cessation of 

 adrenal functions. 



2. The causes of haemorrhage into the adrenals are also those 

 of insufficiency of these organs. 



