PATHOLOGICAL AXATOAIY AND HISTOLOGY 259 



to occur in the reticulata, which is a less resistant layer lying between the 

 firmer fasciculata and the more fibrous medulla. At the same time, the 

 reticulata is especially liable to show before death the effects of toxic 

 substances and it may be that the more frequent occurrence of softening 

 in acute infections may have a basis in ante-mortem disintegration of the 

 reticular cells. 



Congenital Anomalies. Congenital anomalies of the suprarenals con- 

 sist in aplasia, hypoplasia, or various types of dystopias. A complete 

 absence of suprarenals is hardly conceivable, yet cases are reported in 

 the literature of such a condition. Where this total aplasia occurs in 

 non-viable monsters, especially those with extensive cerebral defects, the 

 evidence is conclusive, and cases are cited by authors whose attention was 

 especially directed to the suprarenals and who would not be likely to 

 miss them. But the reported absence of suprarenals in subjects who 

 have lived for a longer or shorter period after birth must be regarded 

 as due to faulty observation. It is certainly significant that cases of 

 total absence of suprarenals in adults are more common in the early 

 literature. One case, which is frequently cited, was reported in 1856 by 

 Martini. This was in a man forty years of age, married, with two 

 children. The patient died of pulmonary tuberculosis and the post- 

 mortem examination showed complete absence of the suprarenals. It is 

 to be noted, however, that there was a horseshoe kidney situated opposite 

 the sacral prominence. Martini states that he examined the kidney care- 

 fully for aberrant suprarenal tissue and was unable to find any trace of it. 

 In spite of this statement a critical reading 1 of the report leads one to 

 believe that the aberrant suprarenal tissue, which must have been present, 

 had been overlooked. 



The aplasia or hypoplasia of the glands in conditions of anencephaly 

 and similar defects of the central nervous system is well authenticated 

 and is of much greater interest on account of the fact that a proper 

 explanation of the changes in these conditions may ultimately lead us to a 

 clearer view of the functions of the cortical portion of the glands. 



Morgagni was the first to note the small size or absence of suprarenals 

 in fetuses in which the cerebral hemispheres failed to develop. Since 

 that time many authors have confirmed the observation, although the 

 majority have found hypoplasia, rather than complete absence, of the 

 organs. It is only within recent years that a true explanation of the 

 character of the hypoplasia has been given. Zander in 1890 gave a 

 careful review of the subject up to that date and gives an extensive study 

 of the proportions of suprarenals to kidney in normal and abnormal 

 fetuses at various periods of fetal life. In 1911 Elliott and Armour, in a 

 paper which described for the first time the postnatal changes in the 

 human suprarenals, described in detail the glands in a full term anen- 

 cephalic fetus. They found that although small, about one-sixth the 



