PATHOLOGICO-ANATOMICAL CHANGES OF THE NERVOUS SYSTEM 215 



of these deviations from the supposed pathology of Addison's disease is too 

 great for us to ignore. 



For us the exceptional cases in which the clinical picture of Addison's 

 disease does not correspond with the adrenal affection are of the greatest 

 importance. They are the ones which even in early years caused doubts to 

 arise regarding the direct dependence of the clinical picture upon disease of 

 the adrenals, and soon caused investigators to search for another explanation 

 of many of the pathologico-anatomical findings. That the first point of 

 attack was usually an investigation into the nervous system is not surprising 

 when we consider the location and intimate connection of certain parts of the 

 nervous system, particularly the abdominal sympathetic plexus, with the adre- 

 nals. At autopsies, special attention has apparently been directed to these 

 parts by the frequent extension of the disease of the adrenals to the surround- 

 ing areas, often in the form of circumscribed inflammation and connective 

 tissue development, more rarely in the form of tumor formation, particularly 

 in important nerve areas. Thus in the last decades a great number of ana- 

 tomical investigations, partly superficial, partly very thorough, have been 

 made of the nervous apparatus surrounding the adrenals, and a great number 

 of results have been obtained, the most important of which will now be 

 briefly sketched. 



PATHOLOGICO-ANATOMICAL CHANGES OF THE NERVOUS SYSTEM 

 IN ADDISON'S DISEASE 



The parts of the nervous system most frequently investigated, and most 

 frequently found diseased, are the semilunar ganglia of the solar plexus. 

 These are naturally implicated by a circumscribed peritonitis or insidious 

 connective tissue inflammation developing from the' adrenals; and thus we 

 find a decided percentage of cases in which these ganglia are reported as 

 adherent to their surroundings, enclosed by connective tissue proliferation, or 

 embedded in cicatricial tissue. It may also be assumed that these conditions 

 are even more frequent than the records show since in the protocols of the 

 earlier observers, adhesions and peritoneal remains have often been reported 

 as present in the surroundings of the adrenals without the sympathetic plexus 

 being mentioned. 



In other cases it is stated that in spite of the connective tissue embedding, 

 normal nerve elements have been demonstrated in the plexus; yet it remains 

 questionable whether these findings included all areas of the nervous organs, 

 and also whether nerve elements pressed upon by tissue of this kind may be 

 looked upon as functionally normal. Such connective tissue proliferation is 

 closely analogous to a compression of the sympathetic plexus by tumors (tuber- 

 culous, carcinomatous, or leukemic) or by aneurism of the aorta. 



With or without such disease of the surrounding tissue, the semilunar 

 ganglia have shown many macroscopic and microscopic changes. The macro- 

 scopic alterations have been noted either as. enlargement, thickening and 

 swelling (and at this not always of the ganglia themselves but frequently 

 also of the nerve bundles extending from them to the adrenals) with hyper- 



