358 CROWELL. 



of granulation tissue beneath it whieli includes many vessels which are the seat 

 of a very marked endarteritis and periarteritis. The proliferated adventitia of 

 the '.vessels frequently contain numerous tuberculous giant cells. Plasma cells 

 are numerous. Chromaffin tissue is present in the cells of the semilunar ganglia 

 in small amount. 



These two cases occurred in the hospital at Bilibid Prison where there 

 is la large number of patients under the care of one physician, and these 

 cases did not attract enough attention to make them the subject of any 

 elaborate physical examination. 



The writer is inclined to believe that the first case was a simple case 

 of adrenal tuberculosis without Addison's disease. However, the second 

 case is more probably one of Addison's disease. The extreme prostration 

 of the patient and the low blood pressure during the last week might 

 possibly have been accounted for by his widespread tuberculosis, but the 

 fact that he was able to be at work until a week before his death would 

 seem to point to some more definite anatomical feature which could ac- 

 count for a lack of some necessary tonic secretion. In this case especially 

 the anatomical evidence is that the adrenals had been functionless for a, 

 considerable time and the final prostration would more plausibly be ac- 

 counted for by the eventual failure of other tissues to carry on the 

 vicarious function of the adrenal. This appears to me to be a very strong 

 point in favor of viewing the adrenals as one part of a system, the 

 complete destruction of which may for a time be compensated for by other 

 parts of the system. Whether this system be the adrenal medulla and 

 the sympathetic nervous system, or the adrenal cortex and some other 

 gland which may act vicariously for it, is not proved by niy experience. 



SUMMARY. 



1. Two clinically certain cases of Addison's diseases have been described 

 in which the adrenals were destroyed by tuberculosis and the semilunar 

 ganglia contained chromaffin. In both of these, other endosecretory 

 glands were the seat of pathologic processes. In one, hypei-plasia of the 

 islands of Langerhans was associated with adrenal and thyroid tubercu- 

 losis; in the other, one parathyroid was cirrhotic. 



8. A case of adrenal tuberculosis without changes in the semilunar 

 ganglia and without recognized Addison's disease occurred in a Filipino. 



3. A second case in a Filipino with adrenal tuberculosis and intact ' 

 semilunar ganglia was probably one of Addison's disease. 



The difficulty of diagnosing Addison's disease in dark-skinned races 

 is great on account of the absence of pathological melanoderma and the 

 possible presence of wide spread tuberculosis. If Addison's disease does 

 occur in dark-skinned races it substantiates the opinion that melanoderma 

 is not an essential feature of the disease, while it emphasizes its impor- 

 tance as a diagnostic sign. 



