84 THE ADRENALS AND THE RESPIRATORY BLOOD-CHANGES. 



feet performance of physiological functions, if the insufficiency 

 be not too far advanced. The bronzing of tuberculosis, syph- 

 ilis, and chronic arsenic poisoning offers many examples of this 

 kind. Syphilitic cases under specific treatment may sometimes 

 be brought to a condition suggesting recovery, for instance. 

 Oestreich 14 witnessed such a result in a case of Addison's disease 

 in which a tuberculous adrenal was removed under the belief 

 that it was a malignant growth. All the typical symptoms of 

 the disease disappeared after the operation, and complete re- 

 covery ensued. This clearly indicates that the toxic process 

 caused by disease of the one gland induced insufficiency of the 

 other, and that as soon as the morbid source was removed what 

 was left normal of the other organ was sufficient for the con- 

 tinuation of life. 



As already stated, hypertrophy of the glandular tissues to 

 meet an increase of physiological work has been brought on 

 experimentally by several investigators, Stilling, 15 Charrin and 

 Langlois, and others, while, as shown below, compensation 

 through supernumerary organs undoubtedly occurs. The op- 

 posite condition to hypertrophy atrophy may, on the other 

 hand, bring the adrenals to the brink of total physiological 

 insufficiency, and thus induce bronzing. But under these cir- 

 cumstances the quality of the secretion may also play an im- 

 portant role in the production of this symptom, the causative 

 condition impaired nutrition being of a nature suggesting 

 such an effect. As the bronzing progresses with the advance 

 of the atrophic process, it may appear long before the severe 

 symptoms of suprarenal insufficiency assert themselves. This 

 type is well illustrated by a case described by Carlin Philips, 16 

 in which bronzing began fourteen years before the onset of 

 the profound constitutional symptoms. Eolleston 17 has em- 

 phasized the fact that atrophy of the adrenals occurs normally 

 in old age, and that it may occur earlier in life and give rise to 

 Addison's disease. 



Total absence of the adrenals has been observed in autop- 



i* Oestreich: Zeitsch. f. klin. Med., Nos. 1 and 2, 1896. 



16 Stilling: Virchow's Archiv, Dec., 1889. 



16 Carlin Philips: Journal of Experimental Medicine, vol. iv, 1900. 



"Rolleston: Lancet, Mar. 23, 1895. 



