262 



J. J. MACKENZIE 



cells in the neighborhood of the necroses. Fig. 2 is a photograph from a 

 typical area t)f focal necrosis in a case of influenzal bronchopneumonia of 

 nine days' duration. 



Edema of the suprarenals is of frequent occurrence in cases dying 

 from acute infections. It is most prominent in the inner zone of the 

 cortex and may be so marked as to increase the size and weight of 

 the gland. 



In all acute infective conditions one meets with marked congestion of 

 the sinusoids. It is most pronounced in the zona reticulata but is not 

 necessarily confined to that. A step further occurs in the presence of 



small focal hemorrhages which 

 may occur anywhere in the 

 cortex. Massive hemorrhage 

 into the glands is not uncom- 

 mon. It has frequently been 

 noted in the new-born and 

 may be a cause of death in 

 these cases. The hemorrhage 

 may lead to complete destruc- 

 tion of the medulla so that 

 the two glands are converted 

 into blood cysts. Sometimes 

 the cortex ruptures and ex- 

 tensive hemorrhage occurs into 

 the perirenal and retroperi- 

 toneal tissue. The actual 

 cause of massive suprarenal 



Fig. 3. Hemorrliagic infarction of the left , i i i, 



suprarenal due to embolism. There was a mural hemorrhage ill tlie new-born 

 thrombus in the left ventricle and emboli in the \\RS not been, demonstrated 

 cerebral vessels, in the left suprarenal artery ., , 



and in the left femoral artery. but a very plausible explana- 



tion is that it has resulted 



from too great or too precocious degeneration of the inner fetal cortex. 

 Elliott and others have pointed out that as this degeneration progresses 

 there is always excessive congestion of the degenerating cortex. In 

 older individuals a variety of causes may act; the hemorrhage here is 

 often in the nature of a hemorrhagic infarction and is due to the throm- 

 bosis or embolism of the vessels of the gland. Fig. 3 shows a hemorrhagic 

 infarction due to embolism. An interesting form of hemorrhagic infarc- 

 tion was first emphasized by Kolisko, occurring in fatal cases of burns. 

 Weiskotten has also reported cases but doubts if the condition is a 

 true hemorrhagic infarction. This hemorrhage into the suprarenals 

 as a result of burns may very well be the immediate cause of 

 death as the amount of destruction of gland tissue is sometimes very 

 great. Fig. 4 is a high-power photograph of a portion of the zona 



