THE ADRENAL BODIES 137 



consist of " cortex " and " medulla " only in mammals. It is 

 possible that pathology may yet throw some light on the 

 question of the function of the cortex and the question as to a 

 possible physiological relationship between the two constituents 

 of the gland. 



We must remember that there are undoubted cases of 

 Addison's disease in which both adrenal bodies are found to 

 be healthy, and that there are other cases in which clinically 

 no signs of the disease are present, but which at the autopsy 

 show destruction of both glands. These facts may possibly 

 find their explanation in the distribution of cortical and 

 chromaphil substance outside the adrenal bodies. On the 

 other hand, it seems not out of the question that we may have 

 to resuscitate a long-buried hypothesis that the disease may 

 sometimes be due to affection of the sympathetic nerves or 

 ganglia. To bear in mind such a possibility is not so unjusti- 

 fiable when we consider to how small an extent we are able to 

 explain any of the symptoms of Addison's disease by anything 

 we have learnt about the functions of the adrenal bodies. 



In the meantime pathologists would do well to investigate, 

 in all cases of probable adrenal disease, not only the adrenals 

 themselves, but the rest of the cortical and chromaphil tissues 

 in the body. 



7. Course and Event of the Disease Diagnosis, Prognosis, 

 and Treatment 



The course of the disease is usually progressive, but the mode 

 of progress is paroxysmal [Greenhow]. All the symptoms are 

 progressive, but not steadily so. The course of the disease on 

 the whole is slow and chronic ; but it is subject to alternate 

 exacerbations and remissions. During the remissions strength 

 is to some extent recovered, but after each exacerbation the 

 patient finds himself upon a lower level than during the 

 previous remission. 



In cases where destruction of the glands is produced by 

 haemorrhages or thromboses death may occur very rapidly 

 with acute nervous and intestinal symptoms. In these pig- 

 mentation is absent. 



In young subjects the disease may run a latent course 

 that is, the constitutional symptoms first appear suddenly in 

 a fully developed form producing death in a few days. 



