352 CROWELL. 



Gall bladder. — ^Contaiiis a considerable amount of dark bile with yellowish 

 sand-like matter suspended in it. Its mucosa is apparently normal. 



Pancreas. — The duct of Wirsung is normal. The pancreas is small, narrow, 

 flat and pale, and weighs 75 grams. There are numerous enlarged and caseous 

 retroperitoneal lymph nodes. 



The gross anatomical diagnosis was: Chronic fibro-caseous tuberculosis of both 

 adrenals; melanoderma; chronic adhesive pleurisy and pericarditis; healed apical 

 pulmonary tuberculosis; healed tuberculosis of bronchial and retroperitoneal 

 lymph nodes; lymphoid hyperplasia of stomach and intestines; chronic paren- 

 chymatous nephritis ; chronic salpingitis and oophoritis ; status lymphaticus. 

 No accessory adrenals were found. The thymus could not be isolated on account 

 of the method of section. 



Microscopically the adrenals showed complete destruction, being entirely re- 

 placed by a central caseous area surrounded by tuberculous granulation tissue 

 containing some miliary tubercles and areas filled with plasma cells. The thyroid 

 showed microscopic tubercles as did the liver and spleen. The pancreas showed 

 a marked hypertrophy of the islands of Laugerhans. Tlie semilunar ganglia, 

 which were the only parts of the sympathetic system preserved, contained 

 chromaffin. • 



The investigation of the chromaffin system in this case was limited 

 to the adrenals and semilunar ganglia, in the former of which it was 

 entirely lacking. Thus far this case might well accord with either 

 Wiesel's or Ivarakascheff's theory and forms alone an insufficient field 

 for theorizing as to the pathogenesis of the disease. However, the simul- 

 taneous lesions in the adrenals, thyroid, and pancreas, form apparent 

 histological evidence of what has been shown experimentally in other 

 connections. Eppinger, Falta, and Eudinger^^^^ have shown that both 

 adrenals and thyroid inhibit the pancreas, and Falta (*°) has reported 

 one case in which after thyroidectomy an undoubted hypertrophy of the 

 islands of Langerhans occurred. In our case there was complete sup- 

 pression of adrenal function and in all probalulity dysthyroidism can be 

 postulated in view of the thyroid tuberculosis. This would remove normal 

 inhibition from the pancreas and lead to the hypertrophy of the islands 

 of Langerhans, which is supposedly histological evidence of hj^perf unction. 



The second case, number 2262, was tliat of a Canadian farmer, 34 years of 

 age, who at 3 years of age had a lesion of the left hip joint which resulted in 

 complete ankylosis. He had had bronzing of the skin for 11 years, and had lost 25 

 pounds in weight in the 3 months previous to his entrance to the hospital, where 

 he sought admission on account of -weakness, soreness of the muscles, and loss of 

 appetite. Aside from his ankylosed hip, pigmentation, asthenia, soreness of the 

 muscles and low blood pressure (8.5 millimeters of mercury) he presented no 

 noteworthy clinical symptoms. 



PROTOCOL 2262. 



The body is that of a well built and muscular adult white male of about 35 

 years. The left lower extremity is 6 to 8 centimeters .shorter than the right 

 and is flexed and adducted. Rigor mortis persists, but is disappearing in toe.g 

 and fingers. Tlie left leg can not be rotated, apparently being fixed at the hip, and 

 is considerably less in circumference than the right at both thigh and calf. The 



