346 THE DISEASES OF THE SUPRARENAL APPARATUS 



that the symptoms on the part of the intestinal tract and the central nervous 

 system, which are severe and remind one of an acute poisoning, depend on the 

 falling out of the function of the cortex. It should further be mentioned 

 that in the growing organism enormous influences on sexual glands and the 

 general hairiness proceed from the cortical system. I shall return to these 

 in detail later. 



Pathogenesis of Addison's Disease. Also the results of the pathologico- 

 physiological investigations just cited justify the dictum that Addison's disease 

 depends on an acute or chronic more or less complete loss of the function of the 

 suprarenal apparatus. 



Probably from youth up there exists in individuals who acquire an Addi- 

 son's disease a certain weakness of the suprarenal function (Wiesel). Almost 

 always we find pathological processes which have affected the suprarenal 

 apparatus itself, but we cannot on this account rule out the assumption that 

 an affection of the nervous apparatus regulating the activity of the suprarenal 

 apparatus cannot lead to a (after a fashion) purely functional Addison's 

 disease. 



Very difficult is the comprehension of the rare cases of Addison's disease 

 with unilateral affection of the suprarenal apparatus that become healed 

 after extirpation of the affected suprarenal, v. Neusser has supposed a 

 reflex influencing of the healthy suprarenal after the manner of reflex anuria, 

 and Bittorf a damaging of the same through abnormal metabolic products of 

 the diseased gland. 



Among the symptoms of Addison's disease depending on the lessening 

 of function of the chromaffin tissue probably are the low blood-pressure, the 

 low sugar contents of the blood, the abnormally high tolerance for grape- 

 sugar, the adynamia, and the mononucleosis or the status lymphaticus, 

 although in the explanation of the alterations in the hematopoietic apparatus 

 we must not forget what is frequently present tuberculosis. To the defi- 

 ciency of the cortical system are referred by most authors the manifestations 

 on the part of the gastrointestinal tract, vomiting, diarrheas, etc., and the 

 psychical alterations, the convulsions, delirium, coma, etc. No certain justi- 

 fication for these views have as yet been adduced (see later) . 



Very difficult is the interpretation of the coming into existence of the 

 pigmentations in Addison's disease. The pigment is always iron-free. 

 On reduction with hydriodic acid it yields no hemopyrrol and on oxidation 

 no hematinic acid. We have, therefore, discarded any relationship with 

 blood pigment, and have found the mother substances in the aromatic split 

 products of albumin (tryptophan, tyrosin, and also adrenalin) (S. Franket). 

 Further, Zuzer and Lichtwitz saw the occurrence of pigmentation of the 

 skin and mucous membranes after the injection of adrenalin in rabbits. As 

 according to Eppinger the melanogen in melanocarcinoma is an N-methy- 

 pyrrolidinoxycarbonic acid and its elimination is increased through the 



