78 THE ADRENALS AND THE RESPIRATORY BLOOD-CHANGES. 



these organs serves to keep united or hold together various bodies 

 entering into the formation of hcemoglobin and that it is concerned 

 with the affinity of this compound for oxygen. 



In man the blood-pigment is more soluble than in animals, 

 and the likelihood of observing similar effects in human blood 

 to those witnessed in that of Boinct's rats is slight. Cutaneous 

 pigmentation and the pigments observed will, therefore, have 

 to form the basis of our inquiry. The first affection to present 

 itself, Addison's disease, will serve a double purpose; it will 

 not only enable us to trace a closer connection between the 

 respiratory blood-changes and suprarenal secretion, but also 

 the manner in which the adrenals exercise their prophylactic 

 mission notwithstanding the inroads of local organic disease. 



Bronze spots have been observed in connection with a 

 variety of disorders in which the adrenals were apparently 

 normal: abdominal growths, diabetes, exophthalmic goiter, 

 tuberculosis, chronic gastric and hepatic disorders, hysteria, 

 pulmonary sarcoma, cholangitis, etc. To conclude, however, 

 as some authors have done, that the adrenals are not involved 

 in Addison's disease or in any other disorder is doubtless in- 

 judicious, since any disease may directly or indirectly implicate 

 the central or extrinsic nervous structures of the organs, in- 

 hibit their nutrition, disturb their metabolism, and in this 

 manner give rise to organic lesions only appreciable micro- 

 scopically. Indeed, it must be admitted that much of the work 

 reported in this connection is quite valueless and, in fact, mis- 

 leading. Arnaud, as already stated, found, in one hundred 

 adrenals picked up at random at autopsies, thirty-six which 

 microscopically showed more or less marked lesions. What can 

 the statement that "the suprarenal glands were found normal" 

 based upon a macroscopical inspection of the organs be worth 

 under these circumstances? 



A single perfectly normal adrenal, we have seen, can com- 

 pensate for an inactive or extirpated mate, and, as no bronzing 

 seems to follow unilateral adrenalectomy, we can at least sur- 

 mise that this symptom will not appear unless the functions 

 of both organs are simultaneously compromised. This is sus- 

 tained by the six cases of adrenal haemorrhage out of the eighty 

 collected by Arnaud, in which true bronzing was present. A 



