SO THE ADRENALS AND THE RESPIRATORY BLOOD-CHANGES. 



organs, may not in some instances prove fatal, and that the 

 physiological functions of the adrenals can be fulfilled vicari- 

 ously. 



Addison's disease with absence of adrenals only shows 

 that the compensation established was insufficient to carry the 

 subject through normal life. Nothnagel's inability to observe 

 pigmentation in 153 animals from which he had removed both 

 adrenals is often quoted to show that these organs are not 

 directly connected with this symptom. But death in all these 

 animals occurred long before bronzing could have appeared. 

 Boinet, on the other hand, who utilized animals in which com- 

 pensatory organs are often found, observed typical pigmenta- 

 tion in all animals that had lived several months after bilateral 

 adrenalectomy. Tizzoni noted the same results after crushing 

 the organs. Various investigators, beginning with Brown- 

 Sequard, had already noted that pigmentation appeared in ani- 

 mals in which the operation did not prove fatal for some 

 months, the symptoms present being analogous to those of 

 Addison's disease. 



On the whole, there appears to be good ground for the 

 belief that: 



1. Addison's disease is a symptom-complex due to insuffi- 

 ciency of the adrenals. 



2. Insufficiency of the adrenals only manifests itself by 

 bronzing when, from any cause, all but a small proportion of the 

 organs has been rendered physiologically inactive. Hence, 



3. Bronzing is a symptom of advanced adrenal insufficiency 

 brought on by any local, peripheral, or general disease. 



Its appearance depends upon the quantity of normal sub- 

 stance, whether this occupy a small area in one organ or be 

 disseminated amidst morbid foci, in one or both of them. 



But how does the pigmentation originate, and why does 

 advanced insufficiency of the adrenals give rise to it? The 

 relation between this terminal stage and pigmentation is evi- 

 dent, while the occurrence of the latter imposes the conclusion 

 that the suprarenal secretion must serve to keep the pigment 

 within its precincts: the red corpuscle. We may ascertain this 

 by locating the seat of dissociation: i.e., the spot where the 

 absence of secretion causes the pigment to leave the corpuscle 



