

THE ADRENAL BODIES 133 



case seems to have been an example of cirrhosis and atrophy. 

 In three cases there were secondary carcinomatous growths 

 in the adrenals, bilateral in one case, unilateral in the other 

 two. In one additional case there was a secondary nodule of 

 carcinoma blocking the right suprarenal vein, and associated 

 with haemorrhage into the corresponding gland, but there were 

 no growths in either. 



Bittorf states that in all cases there is disease of both adrenals. 

 This may be (1) simple atrophy, or (2) inflammatory atrophy 

 (chronic interstitial inflammation) with shrinkage and destruc- 

 tion of the parenchyma, resembling cirrhosis. According to 

 this author, there is no special part of the gland which is of 

 prime importance to life. He considers that the adrenal bodies 

 are single organs, clearly essential to life, interference with 

 which causes a definite train of symptoms. From the tone 

 of this writer it would appear that he does not clearly recognize 

 the essential and fundamental difference between the cortex 

 and the medulla, nor does he appear to appreciate fully the 

 significance of the fact that even if cortex and medulla do 

 really constitute one physiological structure, there are out- 

 standing masses of both constituents in different regions of 

 the body, concerning which it would be out of the question 

 to make a similar hypothesis. There may yet be discovered 

 some reason for looking at the adrenal gland (cortex and 

 medulla taken together) as a functional whole, but Bittorf 

 appears to have come to this conclusion simply because the 

 experimental evidence as to the respective importance to life 

 of cortex and medulla is conflicting, and because pathologists 

 have never yet been able to determine any difference in those 

 cases where chiefly cortex or chiefly medulla have been involved. 



Winkler gives an account of twenty-four cases of adrenal 

 tumours. There were thirteen primary growths (ten epithe- 

 liomata and three sarcomata), and eleven secondary cases. 

 In only two cases was there any bronzing of the skin. . From 

 a careful study of these cases the author is quite unable to 

 decide whether Addison's disease is due to an affection of 

 the cortex or of the chromaphil tissue and the sympathetic, 

 or is to be attributed to a lesion of both together. 



In cases of Addison's disease a fibro-caseous condition of 

 tubercular origin is by far the commonest condition found. 

 In addition, simple atrophy, chronic inflammation, syphilis, 



