326 CLINICAL CONSIDERATIONS 



ness, etc. and permitting him to perform his normal activities 

 without subjective discomfort. Except in rare cases due to 

 syphilis, in which antisyphilitic treatment cautiously adminis- 

 tered should prove curative, we must rely upon a replacement 

 therapy to supply the patient with the vital hormone no longer 

 furnished in adequate amounts by the diseased adrenals. 

 Methods for preparing the hormone, its administration, and 

 dosage have already been described in Chapters XV and XVI. 



The patient suffering from Addison's disease is particularly 

 sensitive to extraneous influences — physical or mental — which 

 tend to excite or exhaust and must be maintained in as calm 

 and unperturbed an atmosphere as possible. Exhaustive 

 examinations are to be avoided. Transportation over long 

 distances has brought on a severe crisis. Extremes of heat or 

 cold must be avoided. Drugs must be administered very 

 cautiously. Purgation has proven fatal in several cases. 538 

 The operative risk of these patients is remarkable; even the 

 extraction of a tooth has resulted fatally. Only when the 

 patient has received an adequate course of treatment with the 

 cortical hormone and has regained his strength should he be 

 subjected to a surgical operation. The administration of 

 large doses of hormone during and following the operation is 

 desirable. Local anesthesia is preferable to the use of a 

 general anesthetic. 540 



The administration of an adequate supply of the cortical 

 hormone should result in an alleviation of the symptoms due to 

 disease of the adrenals. Certain of the bodily deficiences due 

 to the disease may be remedied by other means. Thus the 

 diminution in the blood volume which occurs in crises should be 

 corrected by intravenous injections of glucose and saline 

 solutions. Sodium chloride in Addison's disease has been in- 

 tensively used in recent years since Loeb 399 demonstrated the 

 remarkable clinical benefits derived from the use of this sub- 

 stance. The rationale of sodium chloride therapy is well estab- 

 lished. The loss of this substance from the body in adrenal 



