PATHOLOGICO-ANATOMICAL CHANGES OF THE NERVOUS SYSTEM 219 



of producing the picture of the disease, is evident from the rare cases which 

 have been cited in which compression of the solar plexus, of the splanchnic 

 nerves, etc., by tumors (aneurisms and the like) has been the basis of Addi- 

 son's disease. But how often a similar affection of the nervous system is also 

 present (perhaps late, perhaps from the outset) in the cases running their 

 course with adrenal affection, cannot be decided at this time on account of our 

 insufficient knowledge regarding the nervous findings. The usual course of 

 the common affection will probably be this, that the affection, mostly inflam- 

 matory, starting from the adrenal attacks the surroundings; that is, first, the 

 semilunar ganglion, later, the other parts of the sympathetic, eventually, the 

 cerebrospinal nervous system. The frequency of this course of the disease 

 is suggested also by the fact that those adrenal lesions in which there is an 

 insidious inflammation or some similar process which attacks the adjacent 

 areas are especially apt to cause Addison's disease. To this category belong 

 especially the tuberculous affections of the adrenals, most of which probably 

 depend upon atrophies due to older inflammatory processes; also certain 

 tumors which cause metastases. With the majority of single tumors of the 

 adrenal glands, therefore, there is no Addison's disease, and in the rare cases 

 of adrenal tuberculosis without Addison's symptoms, disease in the surround- 

 ings of the organs has, as a rule, been absent. 



Whether, however, the form of disease with the characteristics of Addi- 

 son's disease, which, starting from the adrenal attacks the surrounding areas, 

 does not also perhaps cause certain changes within the affected nerve areas 

 so that they may develop independently, we cannot say on account of our lack 

 of pathologico-anatomical knowledge. It must be assumed that under some 

 circumstances an analogous but independent disease of the nervous system may 

 take the place of adrenal disease and produce the same clinical picture entirely 

 without implication of the adrenals or with only a late involvement of the 

 glands. 



Physiologic experiments have failed to determine the matter in question. 

 It is true that repeated experiments by extirpation (also cauterization) of the 

 semilunar ganglia have been attempted without, however, furnishing definite 

 conclusions: Previous experiments of this kind (Foa) have been entirely with- 

 out result; and in a more recent series of investigations (Lewin and Boer) 

 in animals which lived thirty days or longer after the operation, only paresis 

 of the intestines, usually with diarrhea, but with no pigmentation or other 

 characteristic changes, was noted. 



The researches next to be mentioned relate chiefly to cases of Addison's 

 disease (with autopsy) in which the adrenals were not implicated, but, on 

 the other hand, certain nerve areas were attacked. A few other cases remain 

 in which the autopsy shows no important changes in the adrenals and none 

 in the nervous system. The number of such cases is small, and from this 

 group many must be excluded in which the diagnosis is questional)le. Of 

 those remaining it is not quite certain from the reports that all of the nerve 

 areas were considered in the investigation and that it was sufficient to exclude 

 any disease. Whether, and how often, cases of this kind exist, minute histo- 

 logic examinatioo of similar doubtful cases must in the future decide. If we 



