THE SYMPATHETIC SYSTEM 141 



reported of rupture of the capsule and to eruption of the 

 blood in the cellular retroperitoneal tissue. 



2. CHANGE OF THE ADRENALS INTO CAVITIES. These 

 also occur quite frequently during infections; it is charac- 

 terized by a softening or a destruction of the medullary 

 substance. It is often unilateral and the other gland appears 

 healthy although showing marked changes histologically. 



3. Occasionally, the gland has a normal appearance. 

 It is hardly enlarged and of a dull white color. In spite 

 of this, the histological lesions are quite extensive. 



Three types of lesions have been found in variable 

 proportions : 



1. Vascular lesions, varying from simple congestion 

 to hemorrhages. 



2. Interstitial lesions characterized by a leukocytic 

 infiltration, sometimes diffuse, sometimes localized to cer- 

 tain points forming small infectious nodules or microscopic 

 abscesses where bacteria can be found. 



3. Degenerative cellular lesions in some places ter- 

 minated by complete necrosis. Various stains bring out 

 these changes quite well. 



These various lesions are found both in infections or in 

 intoxications, whatever their etiology. 



In a general way it can be said, that according to the 

 nature of the toxic agent or the duration of the infection, 

 the alterations shown by the adrenals are: in slow intoxi- 

 cation or mild infections, leukocytic lesions and in acute 

 infections or intoxications, vascular lesions associated 

 with variable cellular lesions according to the disease. 



TREATMENT. 



Adrenal insufficiency is a serious condition, as there is 

 always a possibility of sudden death. It gives the 



