ADDISON S DISEASE 341 



There are also cases of Addison's disease in which the suprarenals are 

 found to be healthy. Nieszkowski, and Virchow, first reported such cases. 

 Lewin found them in 12 per cent, of five hundred sixty-one cases. There are, 

 further, cases in which clinically no signs of Addison's disease are present, 

 but at autopsy show destruction of both suprarenals. v. Neusser hence 

 expressed the thought that a lesion in the splanchnic itself or at some other 

 point of the sympathetic system could lead to Addison's disease. There are 

 but few cases, however (Jurgens, Bramwell), that are adapted for such an 

 explanation; otherwise changes in the sympathetic are rare and mostly slight 

 (v. Kahlden, Martineau}. An explanation of the above-mentioned exceptions 

 would be possible only on the recognition that the suprarenals represent only 

 a part of the chromaffin or interrenal system, and on the consideration of the 

 presence of accessory suprarenals. 



Whether the complete or partial destruction of the suprarenals will in a 

 given case lead to Addison's disease, depends upon the fact whether the por- 

 tion of the suprarenal apparatus lying outside the glands proper is sufficiently 

 well developed to assume the function of the destroyed tissue, apparently 

 also on whether the destruction has progressed slowly enough to give time 

 for vicarious hypertrophy. 



There has taken place a lively discussion as to whether Addison's disease 

 should be referred to a lesion of the chromaffin tissue or the interrenal system. 

 Wiesel in five cases of Addison's disease observed that the entire chromaffin 

 tissue was destroyed, while the cortex seemed to be less affected. He thought 

 that the destructive process began primarily in the chromaffin tissue, and 

 involved the cortex only secondarily. On the other hand, Karakaschejj 

 reported cases in which chiefly the cortex was affected, and in which he 

 regarded the cortical lesion as the sole course of the symptom-complex. The 

 question is not as yet fully cleared up, although the pathologico-anatomical 

 investigations of latter times and the physiological researches tend to show 

 that in Addison's disease a disturbance of function of both suprarenal systems 

 is present, a standpoint that is upheld in the new monographs (Bittorf, 

 v. Neusser and Wiesel, Biedl). Of other pathologico-anatomical findings I 

 mention only the known atrophy of the heart, and the atrophy of the 

 sexual glands that is almost regularly present. Kyrle has made exact in- 

 vestigations as to the testicles. He found a deficient spermatogenesis and 

 also changes in the interstitial glands. 



It is very noteworthy that the suprarenal often becomes affected espe- 

 cially in severely infectious diseases and intoxications. Diphtheria toxin has 

 an especial affinity for the suprarenals. In animals after the injection of 

 diphtheria toxin, the suprarenals are always found to be markedly hyperemic 

 and suffused with hemorrhages (Roux and Yersin). Necroses, hemorrhages, 

 and edema of the suprarenals are found in the various infectious diseases 

 (Oppenheim and Loeper). In many cases, an acute insufficiency of the supra- 



