320 BENSON A. COHOE 



volvement of tfce glands, with cloudy swelling of the cortex, and complete 

 absence of the lipoids, and hemorrhages of varying degree may be observed. 

 In some instances the specific organisms have been obtained from the glands 

 at autopsy. Paisseau and Lemaire have reported the finding of plasmodia 

 in the suprarenals of patients dying from pernicious malaria. Some 

 writers have maintained that the organs are especially vulnerable to cer- 

 tain infections, such as the toxin of diphtheria. An acute hypoadrenia 

 has been so frequently observed in this disease that the designation "sec- 

 ondary syndrome of malignant diphtheria" has been applied to it (Mori- 

 chau-Beauchardt). In the malignant forms of cerebrospinal meningitis 

 an acute hemorrhagic epinephritis was so commonly encountered by Mac- 

 lagan and Cooke as to suggest a selective action of the meningococcus on 

 the chromaphil cells. These authors found a purpuric rash and a hemor- 

 rhagic condition of the suprarenals invariably present in such cases. In 

 some instances the symptom-complex of the acute form of hypoadrenia may 

 occur during the course of an infectious disease. Lowenthal has reported 

 a case of this nature, following an attack of pleurisy and pneumonia, with 

 symptoms of severe abdominal pain, constipation, and a slow pulse, in 

 which at autopsy hemorrhages of both glands were found. Rashbrook 

 and Carter observed the acute syndrome in association with tuberculosis. 

 The patient had repeated attacks of epigastric pain, vomiting and consti- 

 pation, with asthenia and hypothermia. Autopsy showed the suprarenals 

 almost completely replaced by caseous masses. A similar case has re- 

 cently been reported by Boyd, in which the glands were almost entirely 

 destroyed by tuberculous lesions, no trace of medulla being left. One 

 suprarenal showed the persistence of a small strip of cortex. The patient 

 died in coma, a few hours after admission to the hospital, although until 

 that time he had possessed sufficient vigor to engage in the full time duties 

 of a military camp. The acute form has been described in bronchopneu- 

 monia by Sicard, in a case in which he noted extreme myasthenia, low 

 blood pressure and marked hypothermia, and the presence of Sergent's 

 "white line," and in which at autopsy the suprarenals were found to be 

 hemorrhagic. Sajous(&) is inclined to regard the senile type of pneu- 

 monia, characterized by slight febrile disturbance, little or no cough, nor 

 pain in the chest, and the rapid appearance of pulmonary edema, extreme 

 asthenia, and hypotension, as not a true pneumonia, but as the clinical ex- 

 pression of a more or less sudden insufficiency of the suprarenals. The 

 syndrome of hypoadrenia has been very commonly described in the 

 course of typhoid fever. Some writers have, indeed, attempted to ex- 

 plain almost all of the symptoms occurring late in the course of the disease, 

 such as hypothermia, hypotension, dicrotism of the pulse, hypocholesterin- 

 emia, and sphygmothermic dissociation, on the basis of suprarenal insuffi- 

 ciency. It is obvious that such broad conclusions are scarcely justified 

 in the light of our present knowledge of the function of the glands, 



