THE SYMPATHETIC SYSTEM 149 



to the body and limbs; even when diffuse it still keeps its 

 characteristic areolar appearance; it looks like a net work, 

 dirty yellow in color, surrounding areas of non pigmented 

 or healthy skin. 



6. Pigmentation of the mucosa occurs after mercury 

 treatment or in certain races (Roumanians, Tzigans, 

 Bohemians) and in these cases is independent of all 

 pathological affection. 



The objective characteristics of the pigmentation of 

 Addison's disease is, therefore, sufficient to distinguish it 

 from other forms of pigmentation of the skin or mucosa. 



PATHOLOGICAL ANATOMY. 



The lesions found at autopsy in this disease are as follows : 

 1. TUBERCULOSIS OF THE ADRENALS. This is the most 

 common cause. The tuberculosis may be primary (infec- 

 tion through the blood stream) or secondary to a renal, 

 diaphragmatic or pleural tuberculosis. The lesions are 

 quite often bilateral and show many different ana- 

 tomical changes. 



(a) Isolated Tubercles. The gland is increased in 

 size, irregular, but free from all adhesions. A section 

 shows one or more tubercles in various stages of evolution. 

 Sometimes in the beginning stage, in other cases caseated 

 or calcified. These tubercles are more often in the 

 medulla and are surrounded by a shell of cortical substance. 



(b) Caseation. The gland is swollen and irregular. 

 It adheres to the surrounding structures. Its weight may 

 be as much as 20 to 30 grams. On incision it shows a 

 trans] ucid glassy appearance, resembling putty. As a 

 rule the caseation has involved everything but the 

 periphery of the gland. 



(c) Sclerosis. In these cases the glands are absolutely 

 unrecognizable. They are surrounded just as the tuber- 



