ADDISON'S DISEASE 281 



Neoplasms of the suprarenal glands, both primary and secondary, 

 rank next in frequency to tuberculosis and atrophy. Carcinoma, sarcoma 

 hypernephroma, perithelioma, and neuroblastoma have all been noted in 

 cases of the disease. Syphilitic lesions, usually in the form of gummata, 

 with caseation, fibrosis, and infiltration of the surrounding tissues, have 

 been described in a few instances. Esser found gummata in the supra- 

 renals of a new born infant, with symptoms resembling those of Addison's 

 disease. Other rare pathological changes observed in the glands in this 

 disease are echinococcus cyst, mycosis fungoides, and amyloid degenera- 

 tion. Eoth has recently reported a fatal case of the disease, following 

 an attack of pneumonia. At autopsy abscesses were found in the supra- 

 renals, from the pus of which the pneumccoccus was grown. Thrombosis 

 of the suprarenal veins has been noted by Straub(fr) in an acute and fatal 

 form of Addison's disease. 



More recently, as a result of the fundamental observations of Kohn 

 (&), Wiesel (d), and others, on the chromaphil tissue of the body, the at- 

 tention of pathologists has been directed towards careful histochemical 

 study of the entire chromaphil system in cases of Addison's disease. 

 Wiesel first described extensive degenerative changes, and destruction of 

 the chromaphil cells, occurring not only in the medulla of the suprarenal, 

 but also in the chromaphil tissue of the sympathetic (thoracico-lumbar) 

 system, in several cases of this disease. In one case with clinical symptoms 

 of Addison's disease, in which, at autopsy, no lesion of the suprarenal 

 glands was demonstrable, he found an entire absence of certain parts of the 

 chromaphil tissue outside of the glands. According to Wiesel the chroma- 

 phil cells may entirely disappear from the sympathetic system, and the 

 ganglion cells may yield a chromaphil reaction, a phenomenon regarded 

 by Wiesel as compensatory, due to the loss of chromaphil tissue. 



In a small proportion of cases extensive alterations are found in 

 the sympathetic system. The semilunar ganglia and sokr plexus may 

 show degenerative changes, the result of invasion by tuberculous or in- 

 flammatory processes, or pressure by tumors, and may become embedded 

 in cicatricial tissue (Edel). The lesions of the ganglia consist in changes 

 in the ganglion cells, in the vessels, and in the connective tissue sheaths. 

 Cellular infiltration, connective tissue proliferation, and thickening of 

 the capsules of the ganglion cells and of the ntrve sheaths ; pigment atrophy 

 and fatty degeneration of the ganglion cells, and degeneration of the 

 nerve fibers have been described. Fleiner, in two cases of Addison's dis- 

 ease, was able to trace the degenerative process into the central nervous 

 system, in the spinal ganglia, and the extramedullary portions of the pos- 

 terior roots, in the vagus, and in a few peripheral spinal nerves. He 

 found no important changes in the spinal cord. Other observers have 

 described alterations in the spinal cord, but some authorities (v. Kahlden) 



