38 THE PHYSIOLOGY OF THE ADRENALS. 



Thus, advanced' nuclear degeneration is rarely seen in cloudy 

 swelling, while in Wybauw's preparations it is marked, indi- 

 cating the destructive effects. It seems clear, therefore, that 

 we thus have simultaneously pictured, not only the direct 

 effects of the poison, but also the primary effects of excessive 

 activity, the physiological "spontaneous wearing out of living 

 parts" of Virchow having become pathological. 



Cloudy swelling and its almost unfailing sequel, fatty 

 degeneration, represent the dominant processes, however: a 

 statement which suggests that the latter should show itself 

 even more frequently in the adrenals than elsewhere, in con- 

 sideration of the fact that agencies capable of inducing this 

 pathogenic overactivity not only include poisons, but also a 

 large number of diseases, particularly those of childhood. 

 Arnaud, 82 alluding to the evidences of fatty degeneration in 

 the adrenals observed post-mortem, writes: "This lesion, which 

 is appreciable only by histological examination, is very com- 

 mon, as shown by my personal researches. It existed to a more 

 or less marked extent 36 times in 100 subjects whose adrenals 

 had been collected at random at autopsies." Rolleston 83 refers 

 to this subject in the following words: "In the suprarenal 

 bodies of adults fatty change is so common as to be a physio- 

 logical condition. The fat occurs as large globules in the cells. 

 This change may be present throughout the whole of the cortex 

 or be best marked in the zona fasciculata. The medulla is 

 occasionally seen to be occupied by fat, but never to the same 

 extent as the cortex, while in children there is little fat nor- 

 mally. Attlee found, however, some, though slight, fatty 

 change in still-born children. In children dying from maras- 

 mus there was marked fatty change, which was more frequent 

 than in the liver. The cortex was affected in all, and the 

 medulla in 6 out of the 9. Experimentally he found that starva- 

 tion, suppuration, or poisoning, whether acute or chronic, gave 

 rise to fatty changes" 84 : further evidence that all intoxications 

 exercise the brunt of their action upon these organs. And yet 

 Rolleston but voices the present conception of the position 



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



83 Rolleston: Allbutt's "Practice," p. 567. 

 M The italics are our own. 



