5Q DISEASES OF THE KIDNEY. 



ticularly of the cceliac plexus and semilunar ganglia, and of the 

 nerves connecting them with the suprarenal capsules, is of essential 

 importance in the disease. The circumstance which speaks most in 

 favor of this view is, that in most of the cases in which the sympa- 

 thetic has been examined, besides the suprarenal lesion usuallypresent, 

 there has been also found either redness, swelling, thickening, fatty 

 degeneration, atrophy, pigmentation, or wasting of the ganglia. 

 But out of twenty-nine cases collected by Guttmann and Eulenburg 

 the sympathetic was found more or less altered in nineteen and nor- 

 mal in ten. This negative result, though of only a minority of 

 cases, reduces the above attempt at explanation to a mere theory ; 

 the more so when we read that experiments by Adrian Schmidt, 

 Lamansky, Schiff, and others upon the abdominal ganglia give rise 

 to no symptoms suggestive of Addison's disease. A further hy- 

 pothesis was then advanced, that the disorder depended upon 

 derangement of the central nervous system and not upon that of 

 the sympathetic ; and Itossbach describes it as a hitherto undefina- 

 ble functional disturbance of the nervous system lying in close re- 

 lation to, but not inseparable from, the suprarenal capsules, and 

 characterized by psychic disorder, intense anaemia, debility, and 

 very often by a dark staining of the skin. 



In order to account for a connection between a nervous disturb- 

 ance and a morbid stain upon the skin, the cases of albinism have 

 been invoked in which the anomaly is very distinctly limited to a 

 district of skin corresponding to a certain nerve-district, as have 

 also the cases of sudden turning gray of the hair under the influence 

 of mental emotion. The deposits of pigment which form in the skin 

 of pregnant women, and in many who suffer from menstrual and 

 uterine disease, have also been pointed out in support of the view 

 that staining of the skin may proceed from disorder of the supra- 

 renal capsules. 



The anatomical changes of the suprarenal capsules found in 

 Addison's disease are not always the same. In most cases there is 

 a caseous fibrous degeneration resulting from chronic inflammation 

 of the organ. The capsules are often of two or three times their 

 normal size, sometimes even as big as a hen's egg, and are converted 

 into masses of dense connective tissue containing cheesy or calcare- 

 ous nodules. Their surface is irregular and knotty, and often adhe- 

 rent to adjacent structures. Their consistence is tough and hard. 

 The inflammation, instead of being general, may however be only 

 partial and limited to single spots. The disease is generally bilateral. 



The many cases in which both capsules have been found totally 

 destroyed argue against the theory that the suprarenal capsules are 



