PATHOLOGICO-ANATOMICAL CHANGES OF THE NERVOUS SYSTEM 221 



dependent upon tuberculosis), which implicates first the parenchyma of the 

 adrenals and, secondarily, certain nerve areas which are in intimate relation 

 to the adrenals (particularly the abdominal sympathetic and some nerve areas 

 connected with it, perhaps also certain portions of the spinal cord). Since 

 disease of both of these regions may be comhined in various ways, and may 

 also compensate for one another, the peculiar general affection develops which 

 represents what is characteristic of Addison's disease. 



I believe it is impossible to explain in a more definite manner the nature 

 of this general disturbance on account of the missing links in our present 

 knowledge. Prom experimental investigations, and also from the clinical 

 observations which have been outlined, it is evident that from disease of the 

 adrenals a deleterious element appears in the organism, and many theories 

 have been offered to explain the nature of Addison's disease. Almost every 

 one of these is plausible up to a certain degree, but not proven; and almost 

 all explain only a few of the important phases of the clinical picture. Which 

 of these is to be accepted as the most reasonable is merely a matter of 

 opinion in the present status of our knowledge. I need indicate only a few 

 of these : They may be divided in general into, the " toxic " and " nervous " 

 theories, according to whether the changes in the adrenals or those in the nerv- 

 ous system have been assumed to be the more important. Of the first group, 

 recent experiments have made it seem probable that after extirpation of the 

 adrenals the development of substances resembling muscle poisons takes place 

 in the organism. They assume accordingly that the normal " antitoxic action," 

 which is said to be a function of the adrenals, declines or is entirely absent; 

 hence the poisons circulating in the muscles and tissues are able to exert their 

 harmful influence. According to the views of others, the diseased adrenal 

 itself is supposed to furnish the toxins which, by their circulation in the fluids 

 of the body, produce the general affection. Other theories which consider a 

 regulation of cell nutrition to be the normal function of the adrenals ascribe 

 the disease to the development of toxic products by an abnormal activity of 

 the tissue cells which thus leads to the picture of a general intoxication. The 

 theory is plausible that, in consequence of the absence of the normal function 

 of the adrenals, a substance is missing in the fluids which should give to the 

 muscular fibers and other tissue elements the tonus necessary for their normal 

 fimctions. Opposed to this are the theories that the disease is one of the 

 nervous system, especially of the sympathetic, and that Addison's disease 

 arises as part of a general trophoneurosis. Such views emphasize vasomotor 

 disturbances and an unequal distribution of blood in the body, whereby there 

 occurs a hyperemia in the area of the splanchnic nerve with anemia of the 

 peripheral parts; but these views are opposed by the absence in many cases 

 of well developed anemia. Between these groups of opinions are earlier views 

 according to which nothing but a general cachexia (which by some is desig- 

 nated as a tubercular cachexia) is said to be the basis of the clinical picture. 

 The disease is sometimes designated as an " anematosis " (Pepper) depending 

 upon a profound disturbance of blood production, but this view cannot be 

 accepted because of the small number of cases which show blood changes. 

 Many other theories might be mentioned. 



