218 ADDISON'S DISEASE 



cases. Nevertheless, in judging these cases impartially, the impression is 

 received from the reports which have been published regarding the condition 

 of the nervous system, especially of the sympathetic, in Addison's disease, 

 that there is decidedly more in favor than against the presence of important 

 disease of these tissues. This opinion coincides with the results of a later 

 English compilation (Thompson) ; here among 77 records which included 

 minute histologic investigations of sympathetic nerve areas, important changes 

 were noted in 60. 



The question must now be propounded whether, by the aid of these anom- 

 alies of the nervous system, determined in a large series of cases, we can better 

 explain the atypical cases, in which, with true Addison's disease (clinically), 

 no demonstrable adrenal affection is found to correspond. This question must 

 without doubt be answered in the affirmative. As regards the bronzing of 

 the skin it has already been indicated that for its development we must assume 

 an implication of the nervous system, especially vasomotor and trophic func- 

 tions, even in the cases with typical pathologico-anatomical findings. A 

 disease of the essential parts of the abdominal sympathetic and neighboring 

 nerve areas, and particularly changes in these processes with increased forma- 

 tion and transportation of pigment into the region of the cutis layers, may 

 be very readily conceived. In this connection we may point especially to the 

 spinal ganglion, whose influence in producing trophic changes of the skin, 

 according to clinical and experimental investigations, has at various times 

 been especially noted. 



If then no additional knowledge concerning the connection of the adrenals 

 with pigment formation in the body is obtained by further investigations, the 

 pigmentation of the shin in typical Addison's disease (as well as in cases with- 

 out demonstrable adrenal affection) will therefore probably be found related 

 to changes in the nerve areas in question. What then is the relation of the 

 other symptoms of the disease to the lesions of the nervous system ? May they 

 also under these circumstances be referred to nervous disturbance? Up to a 

 certain point such an explanation does not appear unlikely: the characteris- 

 tic lumbar and epigastric pains of Addison's disease are almost the same as 

 those which have long been referred to irritation of the abdominal sympathetic 

 ganglion. Furthermore the intestinal symptoms may be explained by irrita- 

 tion or paralyses of the abdominal nervous system, particularly of the splanch- 

 nic nerve, and the cachexia and other general symptoms may be in part 

 referred to nutritive disturbance due to changed gastric and intestinal func- 

 tions. Naturally the picture of this general disturbance (even without con- 

 sidering the pigmentation) remains a peculiar one, such as we are not accus- 

 tomed to see in most cachexias. And if we look upon the symptoms of the 

 disease as a result of disturbed suprarenal function (particularly the charac- 

 teristic muscular weakness), there would be no barrier for the assumption in 

 these cases of a functional disturbance of the adrenals as a consequence of 

 disease of the nervous areas which influence glandular activity. 



That such a disease of the nervous system, without (or only with a sec- 

 ondary) implication of the adrenals, is capable under certain circumstances 



