- 258 J. J. MACKENZIE 



up suprarenal function and not the least striking feature of this is the 

 more precise indication of the role of the medullary secretion in the 

 normal body. But these precise results of physiology lend very little 

 support to those who would view every case of death with asthenia and 

 falling blood pressure as due to suprarenal exhaustion. 



In spite of this, however, the last ten years have produced a mass of 

 observations upon the pathology of the glands and we are beginning to 

 see evidence of definite association between changes in the normal con- 

 tents of the cortex and medulla and certain general pathological states of 

 the body. 



Post-mortem Alterations. Post-mortem changes are fairly common 

 in the suprarenal glands. As a rule the zona reticulata, or inner layer 

 of the cortex, is the area which shows this most frequently. The change 

 in its earliest manifestation consists in a separation of the cells from one 

 another and a failure of the nucleus to take the nuclear stain. A more 

 advanced state is seen in an autolytic softening of the inner cortical zone. 

 As a result of this softening of the reticulata, the outer cortex may be 

 completely separated from the medulla and the central part of the gland 

 converted into a cavity filled with brownish or hernorrhagic debris. It 

 was this change, noted by several observers in the seventeenth century, 

 which led Thomas Bartholinus to describe the organs as U capsula3 atra- 

 biliara?" (Literature in Biedl(c) Janus, 1910, p. 193). The great majority 

 of pathologists have felt convinced that this condition AVRS purely a post- 

 mortem change and it is so described in all the leading text-books. The 

 greatest possible variation exists in the degree of softening. The rela- 

 tionship of the external temperature and the number of hours which have 

 elapsed since death also shows great variation, so that one cannot say 

 positively that in delayed necropsies and at high summer temperature one 

 will always find softening. At the same time it is more apt to follow 

 deaths from acute infection or conditions where there is congestion and 

 edema of the inner portion of the gland. In a recent paper Materna has 

 returned to a consideration of the question and as a result of his studies 

 he argues that slight degrees of softening or cavity formation are relatively 

 common and are at least agonal in their origin. But he also cites cases 

 in which he thinks that he has been able to demonstrate reparative changes 

 which would indicate an origin some considerable time before the death 

 of the patient. lie does not entirely deny the occurrence of post-mortem 

 softening but argues for a more frequent development of the condition 

 before death. In spite of Materna 's arguments, however, the general 

 experience of pathologists would lead them to regard the extreme softening, 

 which caused observers of the seventeenth century to describe the organs 

 as capsules enclosing a black fluid, as due to post-mortem autolysis. 

 Rough handling of the glands before fixation may increase or aggravate 

 the amount of breaking down of the medulla. This is especially liable 



