206 ADDISON'S DISEASE 



Finally, as an explanation of this problem (as of many others to be men- 

 tioned later) we must remember the presence of the so-called accessory or 

 supplementary suprarenal bodies to which Marchand was the first to call 

 attention. These accessory adrenals are found particularly in the neighbor- 

 hood of the internal genitalia, which have been experimentally proven to be 

 capable of decided hypertrophy after removal of the adrenals. In conclusion 

 it has lately been regarded as settled that after complete- removal of the 

 adrenals a continued healthy existence is impossible. 



More difficult is the decision of the question, what are the disturbances 

 of function in experimental animals after removal of the adrenals? 



In the first place a number of symptoms in these animals may be referred 

 to general nutritive disturbance (mostly diarrhea) ; further some observers 

 have noted lowering of temperature and lowered blood-pressure. Such symp- 

 toms are not consequences of loss of the function of the adrenals, as has lately 

 been often affirmed. On the contrary, they may find sufiicient explanation in 

 the severity of the operation and in various auxiliary circumstances. It must 

 be emphasized, too, that up to the present time, no animal experiment has been 

 successful in producing unmistakably the principal clinical symptom of Addi- 

 son's disease, viz., the pigmentation of the skin. 



In some more extensive series of experiments a few of the animals lived 

 for a longer time and some developed areas of pigment upon the mucous 

 membrane of the mouth or nasal cavity; but it is doubtful whether in these 

 exceptional eases the operation produced the pigmentation. 



On the other hand more conspicuous symptoms relating to the nervous 

 system were observed in the experimental animals. In those that soon suc- 

 cumbed there were convulsions, symptoms of vertigo, rotary movements, and 

 the like; among the animals which lived longer, paralytic conditions, con- 

 tractures, etc., developed. More profound pathologico-anatomical changes of 

 the nervous system have been described only by Tizzoni. In his cases there 

 were lesions in the central nervous system, particularly the medulla oblongata, 

 the cervical cord and cerebellum, as well as in the abdominal plexus of the 

 sympathetic, and certain peripheral nerve trunks. In animals that died 

 quickly the central nervous system showed hyperemia with hemorrhages and 

 cell infiltration surrounding the vessels ; in the cases running a chronic course 

 the changes were more in the form of column degeneration and atrophy 

 of the gray substance. The starting point of the process was apparently the 

 abdominal sympathetic. But nothing analogous to this has been reported by 

 other experimenters. 



Brown-Sequard believed that he could determine important changes in the 

 blood of these experimental animals, particularly a decided increase of pigment 

 with pigment emboli in the organs. From this observation he inferred an 

 intimate connection between the adrenals and pigment formation in the body. 

 But confirmation of these reports by other observers is lacking. Reliable 

 results were furnished by prolonged investigations with the injection of the 

 blood of epinephrectomized animals into healthy animals by Brown-Sequard 

 and by later observers (particularly Abelous, Langlois, etc.). These experi- 

 ments showed, after removal of the adrenals, a conspicuous toxicity of the 



