120 FKANK A. HARTMAN 



monia. HI found that the cortex was often hypertrophied and the epi- 

 nephrin reduced, especially in long continued cases. 



Dietrich has found typical changes in the cortex of individuals dying, 

 of peritonitis., sepsis and gas-gangrene. There were inflammation, 

 degeneration, vacuolization and an increase in the number of lipoid 

 vesicles. 



Diphtheria is said to be particularly specific in producing vacuoliza- 

 tion and hemorrhage of the suprarenals (Thomas). It is also claimed to 

 reduce the epinephrin output (Luksch(a)). 



The simpler organic and inorganic poisons may likewise destroy 

 suprarenal tissue. Porak used strychnin, chloroform, lead and mercury. 

 Graham was also able to produce necrosis, particularly of the cortex, by 

 chloroform, dichlormethane or tetrachlormethane inhalations. Phenol 

 has a similar although less effective action. 



Repair is brought about by division of surviving cells in the whole 

 cortex of the young individual but in the adult such regeneration is largely 

 limited to the zona fasciculata. The chromaffin cells of the medulla also 

 proliferate. 



These conditions must be due to the action of the toxins reaching the 

 gland through the blood stream. Whilst vacuolization might indicate 

 an overactivity, hemorrhage and necrosis point merely to toxic action. 

 The susceptibilitty of the suprarenals to toxins does not necessarily indi- 

 cate that they are detoxifying organs. 



Fatigue Effects. Excessive muscular fatigue leads to vacuolization 

 of the suprarenals (Bernard and Bigart, Bardier and Bonne) and to 

 the disappearance of the lipoid-cholesterol bodies of the cortex (Laignel- 

 Lavastiiie(6)). This indicates either an overactivity of the gland or else 

 a reaction to the toxic products of fatigue, perhaps both. The value 

 of epinephrin in postponing fatigue effects in skeletal muscle immediately 

 suggests an overactivity of the gland. But proof is lacking. In the first 

 place it has not been conclusively shown that the precursor of epinephrin 

 is produced in the cortex. Nor are we sure that epinephrin is released at 

 such a time in quantities sufficient to exhaust the cortex if that were 

 the seat of formation. Such an interpretation therefore must be consid- 

 ered as merely suggestive. 



Suprarenal Changes Following Severe Burns. Although other or- 

 gans are modified Woiskotten finds that the changes produced in the 

 suprarenal are the most characteristic of any occurring in uncomplicated 

 cases of superficial burns. 



"The suprarenals are markedly swollen and deep red. The perisupra- 

 renal fat tissue shows marked edema, On section, certain areas suggest 

 extensive hemorrhage obliterating the normal markings." 



"The gland cells are pale staining and much swollen. Many are 

 apparently undergoing hydropic degeneration. Necrotic cells being in- 



