80 THE ADRENALS AND THE RESPIRATORY BLOOD-CHANGES. 



But why does bronzing not occur in all cases of bilateral 

 organic lesion? To study this feature of the problem we must 

 first eliminate all cases in which the cutaneous changes could 

 not have Lad time to develop. Burns, traumatisms (including 

 compression of the funis or of the body at birth), asphyxia, and 

 toxic processes of various kinds can suddenly produce haemor- 

 rhage into both organs simultaneously and cause death long 

 before any such symptom as bronzing can at all be produced. 

 Almost all hemorrhages observed, in fact, appear to be of 

 recent date. To ascertain the point in question we must, there- 

 fore, not only utilize cases in which very clear post-mortem data 

 are furnished, but also cases in which both glands can be shown 

 to have been diseased sufficiently long to have involved both 

 the parenchyma and the cortex and to have caused bronzing 

 through complete structural disorganization. 



Of the eighty cases collected by Arnaud, but two appear 

 in which both suprarenal capsules seem to have been suffi- 

 ciently diseased to lead us to expect the appearance of bronzing 

 if complete structural disorganization of these organs in its 

 evolution can give rise to this symptom. In Goolden's case 7 

 all the symptoms of Addison's disease were present except 

 bronzing. The autopsy revealed that both organs were prac- 

 tically destroyed. Yet the left organ still contained a small 

 quantity of medullary substance, and the acute symptoms had 

 come on suddenly a few months before with as suddenly devel- 

 oped ancemia. The second case is one of Arnaud's, in which 

 both organs were transformed into large organized hgema- 

 tomata. The patient having been brought into the hospital 

 in a comatose condition, his history could not be traced; but 

 there was no bronzing. The histological data of the neoplasms 

 clearly indicate that they were not of recent formation, while 

 no other visceral lesion could be detected. But again do we 

 find a small area of normal parenchyma in the right capsule. 

 Can we attribute the continuation of the organ's functions and 

 the absence of bronzing to the presence in both cases of these 

 remnants of suprarenal medulla? We probably can, since the 

 work of various investigators Gourfein particularly, as pre- 



Goolden: Lancet, p. 266, vol. ii, 1857. 



