ADDISON'S DISEASE, 355 



The gross anatomical diagnosis was : Caseous tuberculosis of the adrenal 

 glands; chronic coxitis (tuberculous?) ; chronic adhesive pleurisy; chronic ossify- 

 ing myositis of left gluteus medius; hyperplasia of lymphoid tissue of lingual 

 and faucial tonsils, pharynx, larynx, spleen, small and large intestine; congestion 

 of lungs; status lymphatieus. No accessoiy adrenals were found and there was 

 no arterial hypoplasia. 



Microscopically, the adrenals showed the same complete fibro-caseous destruction 

 with only small vestiges of the cortex at one part. The semilunar ganglia 

 contained chromaffin. There were some small cervical nodes which contained 

 healed tuberculous areas. The pancreas and thyroid showed no marked patho- 

 logical changes. One parathyroid which was sectioned was found to be the seat 

 of a very extensive fibrosis, showing only small remnants of the gland embedded 

 in the fibrous mass. The thj^mus gland showed marked hyperplasia. 



Extracts of the adrenal masses were made according to the method 

 ■described by Wells and Greer, (41) and the intravenous injection of 2 cubic 

 centimeters produced no rise of blood pressure in the rabbit. The extract 

 of a normal adrenal, obtained the same length of time after death and 

 prepared in exactly the same way, produced a distinct, sharp rise when 

 0.5 cubic centimeter was injected. In order to eliminate a possible 

 counteracting depressor action of any of the products of caseation, an 

 extract of caseous mesenteric glands from a tuberculous infant was 

 injected intravenously and no change in blood pressure was observed.^ 



Similarly, the extract of the caseous adrenals gave a negative Ehrmann's 

 reaction; that is, it produced no dilatation of an excised frog's eye' in 

 several hours, while the extract of the normal adrenal produced temporary 

 dilatation, as did also adrenalin chloride in 1 in 10,000 solution. These 

 tests were perfonned with naked-eye readings simultaneously under iden- 

 tical conditions of temperature and light, and the independent readings 

 of four observers coincided. This is mentioned because Schultze(42) 

 has devised an elaborate apparatus for observing the pupil and making 

 accurate measurements under constant light and temperature and con- 

 siders naked-eye readings of no value. Oliver and Schaeffer(43) who 

 were the first to describe the angiotonic effect of adrenal extract on 

 intravenous injection, have also found the extracts of the adrenals in two 

 cases of Addison's disease inactive as far as the blood-pressure-raising 

 reaction was concerned. 



The salient features of this second case, then, were prolonged bronzing 

 of the skin, with acute symptoms of Addison's disease lasting 3 months, 



' Since writing this there has come to hand an article by Clyde Brooks in 

 Journ. Exp. Med. (1911), 14, 550, on the Absence of Adrenalin in Malignant 

 Renal Hypernephromas. In this he reports negative physiological tests for 

 adrenalin in (A) Metastatic tissue from an adrenal tumour, 



(B) Two typical hypernephromas, 



(C) Blood from patient with malignant hypernephroma. In his report of the 

 literature he omitted the report of my tests which was published in Trans. N. Y. 

 Path. Soc. (1909), N. S. 9, 80. 



