THE PATHOGENESIS OP BRONZING; ADDISON'S DISEASE. 83 



of the blood-current in the vena lumbaris would induce a con- 

 gestion in the venous tree of the medulla." If we recall the 

 puthogenesis of suprarenal hasmorrhage as reviewed in the 

 earlier portion of this work, the connection between this con- 

 dition and possible valvular lesions of the adrenals will appear. 

 The lymphatic glands bear the same relations to these organs 

 as the nervous system, and give rise to bronzing when in addi- 

 tion to tuberculous processes in distant chains, the peribron- 

 chial, cervical, etc., the abdominal lymphatics are sufficiently 

 diseased to seriously interfere with the suprarenal functions. 

 This sometimes occurs when the abdominal glands alone are 

 affected, as was the case in an instance recorded by Henry 

 Waldo. 13 Their important connection with the diseases which 

 most frequently cause structural lesions of the organs tuber- 

 culosis, cancer, etc. obviously gives them a prominent posi- 

 tion in their pathology. 



Under all these conditions, even with advanced peripheral 

 disease, the organs may appear normal macroscopically and 

 their functional integrity be so compromised as to give rise to 

 bronzing. Structural destruction of one adrenal and functional 

 inhibition of the other through peripheral lesions may also 

 occur simultaneously and thus lead to the belief, at the autopsy, 

 that one organ was normal. Again, the great margin of func- 

 tional power with which these organs are endowed places beyond 

 question the fact that long before a sufficiently extensive in- 

 volvement of both organs can have occurred the patient may die, 

 all the stages of organic lesion appearing post-mortem. Vul- 

 nerable in the extreme, these cases, if the general affection does 

 not carry them away before bronzing will have had time to 

 appear, sink rapidly under the effects of any intercurrent dis- 

 ease, a slight toxasmia, or any condition which spurs their 

 infirm adrenals into any degree of activity beyond the normal 

 needs of the organism. 



All this does not necessarily mean that because pigmenta- 

 tion is present the case is nearing its end in every instance. 

 The causative disorder may become, so to say, latent, and the 

 diminished glandular activity suffice for the more or less per- 



13 Henry Waldo: British Medical Journal, July 10, 1897. 



