204 ADDISON'S DISEASE 



disturbance in nutrition and a change in the composition of the blood, which 

 is generally absent in Addison's disease: The anemia, as a rule, is only devel- 

 oped to a moderate degree in Addison's disease; the red blood count, even 

 in advanced stages, is rarely below 3,000,000 ; the hemoglobin also has been 

 often found comparatively high. The increase of the erythrocytes, which has 

 been lately determined, is not constant and is still unexplained; in one case 

 from 6,800,000 to 7,200,000 were found, and, shortly before death, 6,500,000. 

 The frequently accompanying leukocytosis, with the relative increase of 

 lymphocytes which has been recently reported, was not marked enough to 

 constitute a characteristic change in the blood composition. The pigmenta- 

 tion seen in tuberculosis is not of importance, inasmuch as changes resembling 

 Addison's disease occur only in its late stages; typical cases of Addison's 

 disease, however, are rarely the accompaniments of advanced stages of tuber- 

 culosis. 



In answer to the other question, what consequences are, a priori, to be 

 expected upon destruction of the adrenals, it is necessary to briefly review 

 the reports concerning the anatomy and physiology of these organs. 



ANATOMY AND PHYSIOLOGY OF THE ADRENALS 



Formerly the adrenal was assumed to be essentially a part of the nervous 

 system, and its medullary substance was described as consisting almost exclu- 

 sively of ganglion cells. But the newer histologic investigations are unanimous 

 in this, that the cortical substance as well as the medullary substance contains 

 chiefly parenchyma cells which show a varying size and form in different areas, 

 are arranged in groups inside of a connective tissue structure, and contain 

 very abundant pigment, chiefly in the intermediary zone (Virchow). The 

 rich blood supply of the organs has long been emphasized ; this is shown partly 

 by the comparatively great number of afferent and efferent large vessel trunks, 

 and partly by the very dense capillary network (particularly in the medullary 

 substance). The parenchyma cells are everywhere in intimate relation with 

 the walls of the capillaries, according to some reports in part directly within 

 them. Between the cells, excreted " colloid " masses have ©f late been fre- 

 quently observed (Auld). All authors, even the most recent, agree that the 

 organs (especially their medullary substance) are particularly rich in nerve 

 elements, i. e., in non-medullated (sympathetic) and medullated nerve fibers 

 as well as also in ganglion cells deposited in the parenchyma. Numerous 

 nerves unite the organs with the neighboring parts of the nervous system, 

 particularly with the semilunar ganglion and the other parts of the solar 

 plexus; they have even been followed further, and traced into the splanchnic 

 nerve, the vagus and the phrenic nerve. Some authors have described small 

 ganglion cell groups situated upon the external part of the capsule of the 

 adrenal. 



The conception of the embryologic development of the adrenals differs 

 with various investigators; the majority of observers believe that there is 

 an intimate relation between the medullary substance (which develops sepa- 

 rately from the cortex) and the (sympathetic) nervous system, either assum- 



