82 THE ADRENALS AND THE RESPIRATORY BLOOD-CHANGES. 



phatic supplies of the organs including, of course, their 

 cerebro-spinal connections are liable. The pericapsular 

 nerve-ganglia, for example, which, according to Alezais and 

 Arnaud, 8 may be diseased without implicating the nerves and 

 ganglia of the solar plexus, have been so often found the seat 

 of lesions by these clinicians that, in their opinion, bronzing 

 only occurs when these structures are diseased. Lesions of the 

 sympathetic have so frequently been noted by Lancereaux 9 when 

 bronzing is present that he ascribes this symptom only to ex- 

 tensive disease of the nerves and ganglia of the abdominal 

 sympathetic. That all nervous structures peripheral to the 

 adrenals are involved in the pathogenic process of bronzing 

 has been contended by Fenwick, Greenhow, Jurgens, Raymond 

 and other observers. At the origin of the nervous structures, 

 the spinal axis, Kalendero and Babes 10 found chronic sclerosis 

 of the posterior roots, with marked swelling .of the axis-cylin- 

 ders of the spinal nerves, as main features of a typical case. 

 Bonardi 11 noted in another instance spinal lesions exactly 

 similar to disseminated myelitis of toxic origin. Thus any 

 disease of the nervous supply including the cord may be etio- 

 logically associated with bronzing, but only when, as is the 

 case with local lesions, the morbid process is far advanced. 

 This is readily accounted for when we consider the wide mar- 

 gin of glandular substance present, which likewise insures the 

 continuation of physiological functions even under greatly im- 

 paired innervation. Disease of the semilunar ganglia or of any 

 other nervous structure might thus exist, as it often does, 

 without causing physiologically perceptible lesions of the ad- 

 renals. The vascular lesions are, briefly, those of the general 

 vascular supply, particularly atheroma. 



A kinship to some cardiac valvular lesions is also suggested 

 by the presence of valves in the veins of the capsular plexus, 

 emptying into the lumbar vein, as shown by J. M. Flint, 12 who 

 says: "Thus the circulation in the medulla depends somewhat 

 on the condition of pressure in the lumbar vein, and stagnation 



8 Alezais and Arnaud: La Semaine Medicals, Oct. 7, 1891. 



9 Lancereaux: Archives Generates de Medecine, Jan., 1890. 



10 Kalendero and Babes: La Semaine M6dicale, Feb. 22, 1889. 



11 Bonardi: Revue Neurologique, Aug., 1897. 



12 J. M. Flint: Johns Hopkins Hosp. Reports, vol. ix, 1900. 



