January 24, 1908] 



SCIENCE 



129 



probably, by increasing susceptibility to 

 bacterial and allied infections, but often 

 through direct chemical and physical mal- 

 inflnences. A wide-spread interest in the 

 improvement of the physical condition of 

 the race, which has grown out of the social 

 propaganda for bettering the condition of 

 the poor, has produced in many quarters 

 an active inquiry into the pathology of the 

 occupation diseases from which much en- 

 lightenment may be confidently expected. 

 But a complete knowledge of these external 

 agencies, when it shall have been acquired, 

 will probably fail to secure to us a full 

 knowledge of the conditions which underlie 

 all disease, since there is a class of diseases, 

 some of very subtile nature, apparently, 

 which result, in part at least, from errors 

 and disturbances of balance in the develop- 

 ment of the animal organism or in the cor- 

 relation of its functions, of which we are 

 at present beginning to appreciate the sig- 

 nificance. The remarkable chain of events 

 through which the function of one organ 

 or set of tissues is determined and con- 

 trolled by the secretion of another organ 

 or set of tissues, as is displayed in the 

 influence of excessive or diminished thy- 

 roid secretion on the state of nutrition of 

 the body and functions of its important 

 viscera, and of the metabolic products of 

 fetal tissues upon the hypertrophy and 

 growth and function of the mammary 

 gland, can serve to indicate how dependent 

 is progress in pathology upon knowledge 

 ©f physiology and chemistry. 



Physiology, pathological anatomy and 

 experimental pathology having each con- 

 tributed a share which the others could 

 not have supplied, are promising to solve 

 some of the problems of arterial hyper- 

 tension and arterial degeneration in 

 Bright 's disease. The peculiar control 

 which the adrenals exercise over the tone 

 of the vascular system can be altered in 

 two ways so as either to depress and relax 



the circulation or to exalt and increase its 

 tension. The first, a result of ablation or 

 tubercular disease, as in Addison's disease, 

 is clearly of extrinsic origin; but the 

 second, which is associated with certain 

 changes in the gland of an adenomatous 

 character, may not be so. It is this latter 

 condition which has now been found a 

 number of times in cases of sclerosis and 

 atrophy of the kidneys associated with 

 arterial hypertension and degeneration. 

 Recalling the effects of adrenalin in in- 

 creasing blood pressure, of the degenera- 

 tions of the aorta produced in rabbits by 

 injections of this drug, and the clinical 

 phenomena in this class of cases of Bright 's 

 disease, it seems a natural step to associate 

 the adrenal, the nephritic and arterial 

 disease into one pathological complex. 

 Whether the primary pathological condi- 

 tion is to be discovered in the kidneys and 

 the histological alterations in the adrenals 

 are consequent upon this, as the arterial 

 degenerations are viewed as secondary to 

 the changes in the adrenal, or the order is 

 to be reversed, in which case the changes 

 in the kidneys are to be conceived as fol- 

 lowing upon those in the arterial system, 

 can only be surmised at the present time. 

 But we may still view this tangible basis 

 of observation and possibly of experiment 

 with hope that in it somewhere may be 

 found the key to the understanding of 

 this complex and vastly important chapter 

 of pathology. 



Examples showing the importance of 

 glandular integrity in maintaining a state 

 of health and of disintegi-ity in producing 

 diseases could, with our present knowledge, 

 be multiplied so as to include most of the 

 glandular organs. Many of these ex- 

 amples would be familiar to you. In some 

 of the best understood examples the num- 

 ber of possible alterations in the glands is 

 two, at least, and the pathological effects 

 are different according as the secretion is 



