addison's disease 325 



of methods for detecting the disease in its initial stages is very 

 desirable. 



The emphasis placed on epinephrine as the assumed hormone 

 of the adrenals and its remarkable pharmacological effects led 

 to its early application in Addison's disease. The administra- 

 tion of epinephrine, hypodermically and rectally, and of ad- 

 renal substance, by mouth, formed the basis for the so-called 

 Muirhead 461 treatment. Recent studies have demonstrated 

 that lack of epinephrine is certainly not responsible for the 

 symptoms of Addison's disease. Injection of epinephrine 

 into adrenalectomized animals is not only not beneficial but 

 very harmful. It is logical to conclude, therefore, that epi- 

 nephrine is not only of no value but is to be avoided in patients 

 with Addison's disease. The use of dried glandular materials 

 either in the form of a desiccated powder or as a glycerine 

 extract, as advocated and used in the past, are also to be 

 deprecated. The slight possible usefulness of these prepara- 

 tions is overbalanced by the deleterious effects of the large 

 amounts of epinephrine and its phenolic derivatives which 

 these preparations contain. 42 ' 249 In the doses in which they 

 are tolerated, no conceivable benefit could be derived, for it 

 would require over a kilogram of most of these preparations 

 to furnish enough of the hormone for the daily need of a pa- 

 tient manifesting symptoms of adrenal insufficiency. Even the 

 use of fresh glands would require an amount of material beyond 

 the digestive capacities of even a normal individual. 246 Hence 

 we must utilize concentrates derived from large quantities of 

 glands. The potency of the preparation and its freedom from 

 noxious impurities must be demonstrable by experiments on 

 adrenalectomized animals. 



There can be no doubt that the symptoms of Addison's 

 disease are due to an absence of the vital adrenal cortical hor- 

 mone. Hence the first requirement of successful therapy must 

 consist in supplying an amount of this hormone adequate for 

 relieving the patient of asthenia, gastric disturbances, weak- 



