GROSSER PATHOLOGICO-ANATOMIOAL LESIONS 211 



This asthenia in Addison's disease may also be alleged as valuable proof 

 of the theory of many observers that the function of the adrenals mainly 

 consists in the maintenance of the muscular tonus. 



The cardiac weakness so frequently noted in Addison's disease, which 

 numerous authors have also observed in the animals operated upon, may in 

 some respects be regarded as a part of the general muscular weakness. Obvi- 

 ously this must be looked upon as an expression of the fact that a disturbance 

 of the adrenals has decreased or abolished the formation of a substance which 

 increases blood-pressure and strengthens the heart, and which according to 

 the investigations we have mentioned must be ascribed to the parenchyma 

 of the organ. 



In regard to the manifold disturbances originating in the digestive canal 

 and its surroundings, practical experience at the bedside coincides with experi- 

 mental results and theoretic deductions: The majority of the gastric symp- 

 toms, such as general dyspepsia, particularly loss of appetite, gastric oppres- 

 sion, eructations, nausea, vomiting, etc., may be referred to the general 

 affection with its adynamia, anemia, etc. The epigastric, hypochondriac, and 

 lumbar pains which are never absent, and occasionally form the most distress- 

 ing of the subjective symptoms, may be directly due to pathologic processes 

 in the adrenals themselves. Experimental investigators have repeatedly de- 

 monstrated that the adrenal, particularly its medullary substance, is very sensi- 

 tive to pain. The frequency, too, with which the adrenal affection attacks 

 the surrounding areas, in which are found signs of old local peritonitis in the 

 form of adhesions and connective tissue masses, certainly points to a similar 

 explanation of these pains. But though we cannot be sure of the connection 

 between these pains and the chronic and progressive inflammation, a terminal 

 stage of the Addison symptom complex resembling peritonitis has of late been 

 frequently described (Bbstein). To explain the intestinal symptoms, the same 

 factors may suffice, but we may also call to mind the above-mentioned experi- 

 ments which show a nervous connection between the adrenals and the intes- 

 tinal ganglia and suggest that inhibitive nerve impulses are normally 

 transmitted from the adrenals to the intestine, so as to control intestinal 

 movements. The diarrhea which appears in the terminal stage of the disease 

 is a particularly strong argument for this view. 



It is less easy to ascribe to a simple adrenal defect some of the many 

 nervous phenomena which accompany the disease. The general nervous symp- 

 toms and the milder forms of cerebral implication such as apathy, headache, 

 insomnia, vertigo, attacks of syncope and the like may be related to the ady- 

 namic and anemic general condition. JSTevertheless, these symptoms are often 

 much greater than can be accounted for by the general asthenic conditions; 

 for example, the apathy often changes into increasing psychical depression 

 ■with disturbance of the mental functions, showing itself partly by somnolence, 

 partly by irritability. To this may be added the neuralgic conditions often 

 observed in the earliest stages, especially affecting the extremities and the 

 joints, and finally, the usually spasmodic, often epileptiform attacks, accom- 

 panied by extreme irritability and delirium which lead up to the final coma 

 of the later course. If this picture is considered, it corresponds neither to a 



