GROSSER PATHOLOGICO-ANATOMICAL LESIONS 205 



ing a direct development of the adrenal medullary substance from the ganglion 

 of the sympathetic, or a later growth from the sympathetic ganglion cells and 

 nerve fibers. 



In spite of many points which are still obscure the complicated anatomical 

 structure of the adrenals gives us the impression that they are (ductless) 

 secretory organs, constructed with a comprehensive innervation apparatus. 



Still more complicated, and in many respects uncertain, is our knowledge 

 of the physiologic function of the adrenals. 



For a long time they have been classed with the well known glandular 

 ductless organs, being designated as blood-vessel glands serving an unknown 

 purpose. Particular attention was drawn to the adrenals by the first descrip- 

 tions of the Addison symptom-complex, and this caused a deeper scientific 

 interest regarding their importance, and the investigation of their function. 

 And thus, soon after the publication of Addison's views, a series of experi- 

 mental researches were begun which had for their purpose the extirpation of 

 the adrenals in animals, and the observation of symptoms thus produced, in 

 order to determine the functional importance of these organs. 



But the difficulty of such investigations was soon shown in the uncertainty 

 of the results. This gave rise to the important question, whether the adrenals 

 were to be looked upon as organs necessary to life. This question was an- 

 swered definitely in the affirmative by the first investigator, Brown-Sequard; 

 in a publication in 1856 he stated that after removal of both adrenals all the 

 animals died in a short time (one to two days) with prostration and severe 

 nervous symptoms. But his reports were at first not confirmed by other ob- 

 servers; on the contrary, there soon appeared a number of communications 

 (among which I shall mention only those of Philippeaux, Gratiolet, Harley 

 and Schiff), according to which certain animals, in spite of the loss of both 

 adrenals, continued to live for a long time (several months), and from which 

 it appeared likely that the death of the experimental animals was produced 

 by lesions of neighboring parts (peritoneum, abdominal nerve plexus, etc.). 

 At this point I must refer to a series of experiments by Nothnagel, who 

 produced bilateral contusion of the adrenals in a great number of rabbits, a 

 few of which were still living eighteen months later and showed no gross 

 lesions. 



Thus the vital importance of the adrenals was for a long time a subject 

 of doubt. But a series of new investigations substantiated the original opinion 

 of Brown-Sequard. These (conducted by Tizzoni, Abelous and Langlois, de 

 Domenicis, Cybulski, Szymonowicz and others) showed that in a number of 

 different animal species (dogs, guinea-pigs, frogs, etc.) death invariably re- 

 sulted after a complete removal of both adrenals. 



The period before death varied (according to the animal and according 

 to certain auxiliary conditions) from a few hours up to several months. By 

 careful control experiments it was shown that only the loss of the adrenals 

 could be the cause of death. An opposite result has been obtained in some 

 investigations, very few of them recent. This contradiction may be explained 

 in various ways: Either the observation of the animals may have been too 

 brief, or the removal of the adrenals was incomplete. 



