216 ADDISON'S DISEASE 



emia and abnormal succulence; also decrease in size, atrophy and induration. 

 In some cases the ganglia have been implicated in a process of caseation 

 (tumor formation is also mentioned). Histologic investigations have shown 

 the signs of fresh or older inflammation and degeneration with their conse- 

 quences, particularly interstitial connective tissue proliferation, cellular infil- 

 tration and thickening of the capsules of the ganglion cells and nerve sheaths; 

 moreover, abnormal pigmentation of many tissue elements, fatty degeneration 

 and pigment atrophy of the ganglion cells (occasionally reaching a very high 

 grade). Finally there are observations of various forms of neuritis, atrophy 

 and degeneration of the nerve fibers traversing the ganglia and proceeding 

 from them. Conspicuous vascular changes (thickening and hyaline degenera- 

 tion of the walls of the vessels, accumulation of cells and hemorrhages in the 

 adventitia) have also been noted, particularly in the areas near the adrenals 

 (v. Kahlden). 



The same changes (thickening, contraction, degeneration of ganglion cells 

 and nerve fibers) have also been frequently found in other parts of the 

 solar plexus. 



Various observers note far-reaching degeneration of the splanchnic nerve, 

 partly in the form of fresh or older neuritis, partly as gray degeneration of 

 the medullary fibers, the latter sometimes as consequences of compression; 

 for example, by an aneurism of the aorta (Jiirgens). 



Similar neuritic disease has been found in the sympathetic system, some- 

 what removed from the adrenals, particularly in the boundary column of the 

 sympathetic and in its cervical ganglia. The former has often been found 

 conspicuously thickened and indurated, the latter decidedly swollen, and show- 

 ing inflammatory changes. Fleiner was able to follow similar processes of 

 the disease through a large part of the sympathetic nervous system, and also 

 in two cases in the central nervous system. These findings are the more 

 convincing as in both cases they were quite similar, while the nature of the 

 disease differed decidedly (one was dependent upon tuberculosis of both adre- 

 nals, and the other upon sarcomatosis of an adrenal and its surroundings). 

 In both instances a chronic process of inflammation could be demonstrated 

 which extended from the diseased adrenals through the semilunar ganglion 

 to the boundary column of the sympathetic with its thoracic and cervical 

 ganglia into the pneumogastric, and was particularly well developed in the 

 intervertebral ganglia of the posterior thoracic and upper lumbar portions of 

 the vertebral column. In all of these areas there was found diffuse connective 

 tissue proliferation, or focal accumulation of round cells in the neighborhood 

 of vessels; besides this markedly intense pigment atrophy of the ganglion 

 cells, and extensive degeneration of medullary fibers in the sympathetic, the 

 splanchnics and also in the vagus. In the spinal ganglia the nerve fibers 

 showed advanced degeneration, most markedly in the nerve branches leading 

 to the sympathetic, less so in those leading to the posterior roots of the spinal 

 cord. Finally, the same degenerative processes were found in a number of 

 peripheral nerves, chiefly in the sensory cutaneous branches. 



In the spinal cord the same observer found no important changes, but such 

 have repeatedly been described by others (Burresi, Babes and Kalind'ero, etc.), 



