288 BENSON A. COHOE 



may suffice ,to give rise to the disease. Wiesel does not, however, deny 

 the important role the cortex may play in the causation of the disease, 

 and is of the opinion that for the production of some of the more severe 

 clinical symptoms an involvement of the cortical tissue is necessary. At 

 the present time this theory of chromaphil cell inadequacy, as the primary 

 factor in the causation of the disease, is becoming quite generally accepted. 

 If the theory be correct some of the cases of Addison's disease, without 

 destructive lesions of the suprarenal glands, which were formerly regarded 

 as of purely functional origin, might be explained on the basis of chroma- 

 phil inadequacy, since lesions in the chromaphil tissue outside of the supra.- 

 renal were probably overlooked by the earlier pathologists. Beitzke has 

 brought forward confirmatory evidence in favor of this theory in a case 

 of cancer of the suprarenals, without the Addisonian syndrome, in which 

 the chromaphil tissues outside of the suprarenals were found intact. Some 

 writers, while subscribing to the theory of chromaphil inadequacy, have ex- 

 tended it to embrace a lesion or irritation of the sympathetic nervous sys- 

 tem, innervating the chromaphil tissue, suggesting that a lesion of these 

 nervous structures may occasion a cessation of the gland function (Neus- 

 ser ) . 



In the opinion of some authorities a lesion of the cortex (interrenal 

 system) is the factor of primary importance in the causation of the dis- 

 ease. Karakascheff has reported cases of Addison's. disease, in which 

 the destructive lesion mainly involved the cortical tissue. The clinical 

 symptoms in these cases, in his opinion, were due to a loss of cortical cells, 

 and he was unable to confirm WiesePs findings of a general involvement 

 of the chromaphil tissue. Lowy has also described a case of Addison's dis.- 

 ease, running a very acute course, in which he) attributed the clinical 

 symptoms to destruction of cortical tissue, since he found only medullary 

 tissue persisting in the suprarenals at autopsy. Scott believes that the 

 destruction of the suprarenal medulla should not be especially harmful, 

 in the presence of the wide occurrence of chromaphil tissue outside of 

 the medulla. He accordingly ascribes the disease as due to a loss of cor- 

 tical tissue, in view of the fact that accessory cortical tissue is a variable 

 quantity. (Bittorf (a), on the other hand, is inclined to regard the supra- 

 renal as a single organ, no special part of which is of primary importance 

 in the causation of the disease. 



The recent observations of the frequency of the association of hypo- 

 plasia of the chromaphil system with slatus tliymicolympliaticus have an 

 especial interest in relation to the theory of chromaphil inadequacy as 

 the cause of Addison's disease. Reports in the literature of the finding of 

 an enlarged thymus, and of the occurrence of lymphocytic nodules in the 

 thyroid gland (l)ubois) appear to be on the increase. It has been sug- 

 gested that the normal involution of the thymus is caused by a depres- 

 sive influence of epinephrin upon this organ. If this hypothesis be true, 



