268 J. J. MACKENZIE 



the union was complete, the cuprarenals of the partner showed the same 

 degree of change. He points out that it is a curious fact that the most 

 varied forms of intoxication may lead to this characteristic morphological 

 evidence of suprarenal exhaustion and that therefore it is much more 

 plausible to regard this exhaustion as the result of some general systemic 

 condition. He suggests that the disappearance of lipoid may be due to 

 mobilization of these,, brought about by the necessity of neutralizing 

 excessive proteolytic enzymes in the blood, set free by the primary intox- 

 ication. This, however, is pure hypothesis and needs much more evidence 

 for its foundation than we have at present. 



The supposed connection between hypertrophy of the suprarenals and 

 conditions of arteriosclerosis with hypertension, which w.as specially in- 

 sisted on in the first instance by Schur and Wiesel(c) and by numerous 

 French authors, has not been borne out by further study. The idea un- 

 doubtedly arose from the known effect of epinephrin upon the blood pres- 

 sure. Study of the glands showed, however, no increase in the medulla but 

 sometimes increase of cortex and especially the occurrence of adenomata of 

 cortical material either outside the gland or within the medulla. Compara- 

 tive studies have clearly shown that there is no relationship between ad- 

 enomata of the cortex and hypertension although they may be somewhat 

 commoner in older individuals. 



Abscess formation due to metastatic foci in pyemic conditions is rare 

 but is sometimes found. 



Tuberculosis of the suprarenals is the characteristic finding in Addi- 

 son's disease. Miliary tubercles are reported as not common, but careful 

 study of the suprarenals in general miliary tuberculosis will usually reveal 

 a few small foci. In Addison's disease, on the other hand, the process is a 

 slow caseating one with apparent increase in size of the gland and .areas 

 of extensive fibrosis often with calcification. 



Syphilitic disease of the suprarenals is not common, or at least has 

 not been commonly reported. In acquired syphilis it usually consists in 

 isolated or fused gummatous masses, with more or less destruction .of the 

 gland tissue. In congenital syphilis the suprarenals as a rule are literally 

 swarming with the organisms. In spite of this, however, the histological 

 change is relatively slight and not by any means as extensive as similar 

 congenital lesions of the liver and lung. Focal necroses are fairly common, 

 ii'iimmata also occur ; sometimes areas of interstitial fibrosis are found. 

 Simmonds(fr) has described as the most common characteristic of congen- 

 ital syphilis an infiltration and fibrosis of the capsule of the gland ; what he 

 designates perihypernephritis syphilitica. 



Suprarenal Pathology in Addison's Disease. Since the classical de- 

 scription of the pathology of the suprarenals in this disease by Addison(&) 

 in 1855 an enormous amount of work upon the changes in the glands and 

 the chromaphil system has been carried out. With all this work, however, 



