On Addison's disease : clinical lectures on Addison's disease and a report on diseases of the supra-renal capsules / by Edward Headlam Greenhow.

  • Greenhow, Edward Headlam, 1814-1888.
Date:
1866
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Licence: Public Domain Mark

Credit: On Addison's disease : clinical lectures on Addison's disease and a report on diseases of the supra-renal capsules / by Edward Headlam Greenhow. Source: Wellcome Collection.

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    was beginning to soften at one or two points in the right lung. There were also two or three smaU masses of grey tubercle in the lower lobes ot both lungs. Neai-ly colourless clots of moderately firm consistence were found in all the cavities of the heart, adhering to the musculi pectmati and chordte tendinese, and extending into the great vessels. There were a few smaU reddish patches of congestion near the pyloric extremity of the stomach. In the lower part of the ileum Peyer's glands were more prominent than usual, and the mucous membrane was somewhat congested; the solitaiy glands were also enlarged, and a few of them were opaque and slightly yellow. The supra-renal capsules were both much enlarged and their fibrous envelopes thickened. The right capsule was fii-mly adherent to the liver, kidney and dia- phragm, and the left to the kidney and diaphragm. Both capsules were hard and somewhat nodulated; and, on section, no trace of the normal structure could be discovered, nor any distinction between cortex and.medulla. The natural substance of the organs was chiefly replaced by masses of opaque yellow matter, partly of cheesy consistence and partly friable, separated fi-om each other by a greyish semi-trans- parent tissue of tough consistence. Beneath the thickened fibrous envelope of the right capsule was a small collection of puriform fluid. The disease was apparently less advanced in the left than in the right capsule, there being a larger portion of the greyish semi-transparent tissue, and smaller deposits of the cheesy material, in the former than in the latter.* * My friend and colleague Dr. Burden Sanderson made at my request a micro- scopical examination of the left supra-renal capsule from this patient, of which I append the notes already published in the Transactions of the Pathological Societij, Vol. xvi., p. 249. The capsule, which is still attached to the kidney, is of the size and shape of a walnut. It is closely invested with a covering of dense fibrous tissue, about half an inch in thickness, which is in some parts separable from the external sur- face of the organ, in others firmly adherent, and, as it were, incorporated with it. In the section of the organ no distinction can be made out between rind and kernel; but it exhibits several varieties of structure and consistence without de- finite azTangement. Some parts are of a pinkish colour, somewhat translucent, and of firm consistence ; others are white, soft, of a consistence aijproaching to cream-cheese, and occasionally gritty. Between these there are various grada- tions ; thus in many parts the tissue has lost its translucency and colour, but not its consistence. Between the translucent parts and opaque parts there is a great difference in structure, as shown under the microscope. The former exhibit (even without the addition of acetic acid, and much more distinctly after the addition of that re-agent) nuclei which ai-e embedded in a finely granvdar stroma. The granular appearance is owing partly to albuminous gi-anules (which disappear