82 BENSON A. COHOE 



regard these as not a specific result of suprarenal disease, since such 

 changes have been commonly noted in other conditions. 



Microchemical studies of the suprarenal glands, in regard to de- 

 termining the epinephrin content of the medulla, and the lipoid content 

 of the cortex in Addison's disease, have so far been limited in number, 

 although considerable work has been accomplished in estimating these 

 bodies in other pathological conditions by several observers. Elliott (e) has 

 shown that the normal suprarenal of an adult man weighs between 3 

 and 4 gm. and contains 4-5 mg. of epinephrin. Lucksch(c) states that the 

 epinephrin content of the gland is less in Addison's disease than in any 

 other pathological condition. Sydenstricker, Delatour and Whipple ob- 

 served that tuberculous disease of one suprarenal may be associated with 

 an increased epinephrin content of the intact gland. 



The pathological changes in other organs in Addison's disease are not 

 of great importance, and are such as usually occur in prolonged illness. 

 The spleen may be enlarged. The heart frequently shows atrophic changes. 

 Tuberculosis of the lungs, and of the mediastinal glands, is present in 

 about half of the cases. Arteriosclerosis is regarded as an uncommon find- 

 ing by most authorities, although Neusser states that atheromatous changes 

 in the blood vessels are frequent, even in young persons, in this disease. 

 The pigmentary changes in the skin and mucous membranes represent 

 simply an augmentation of the normal pigment deposit. The pigment 

 granules are found in the rete Malpighii, and are iron-free. 



As yet, only a few observations have been recorded concerning the pres- 

 ence of pathological alterations in other endocrin glands in Addison's 

 disease. A persistent thymus was first noted by Star, and has since been 

 observed by several writers. It seems probable that status thymicolym- 

 phaticus is commonly associated with Addison's disease. A few observers 

 have described cases of this kind. Alterations in the thyroid have been 

 frequently noted, a decrease in size being found more often than an en- 

 larged gland. The association of Addison's disease with hyperthyroidism 

 has been observed in some instances. Dubois recently found lymphoid 

 foci in the thyroid in six cases of Addison's disease. This formation of 

 lymphatic tissue, with typical germinal centers, he regards as having some 

 relation with status lymphaticus. Apart from atrophy of the gonads, 

 which Falta(c) has stated to be almost invariably present, but few com- 

 ments have been made in the literature concerning the involvement of the 

 other endocrin glands in this disease. 



Pathogenesis. The obscure pathogenesis of this disease has proven 

 an incentive for much speculation and theorizing upon the part of 

 clinicians, and for extensive experimental research upon the part of in- 

 vestigators in the various pre-clinical fields. The history of the develop- 

 ment of the modern theory of the disease forms an interesting chapter in 

 medical science. Addison's original conception of the origin of the dis- 



