364 CLINICAL CONSIDERATIONS 



fortunately we are at present ignorant of these conditions and 

 can only surmise as to their nature and causative agents. 

 Further clinical investigation and a study of the therapeutic 

 effects of administration of the cortical hormone should 

 elucidate these problems. 



One would anticipate that hypofunction of the adrenals 

 should result in some of the symptoms which characterize 

 insufficiency in experimental animals or patients with Addison's 

 disease, viz., asthenia, gastro-intestinal disturbances, a tend- 

 ency to infection, etc. Unfortunately these symptoms are 

 also characteristic of other pathological conditions as well, 

 and hence, to attribute indiscriminately any condition charac- 

 terized by one or more of these symptoms to adrenal insuffi- 

 ciency is unjustified. On the other hand, one is justified in 

 our present state of ignorance to apply the therapeutic test in 

 any given case in which there is a suspicion of adrenal hypo- 

 function. For example, animals subjected to excessive heat 

 require an excessive amount of the cortical hormone. It would 

 seem logical to hypothecate, therefore, that the denervating 

 effects of heat may in part at least be a result of a mild degree 

 of adrenal cortical insufficiency. The experimental adminis- 

 tration of the hormone to a statistically significant number of 

 cases with proper controls and avoidance of vitiating factors 

 would determine the validity of the above hypothesis. 



A number of acute and chronic diseases may cause degenera- 

 tive changes in the adrenals and it is logical to conclude that 

 such changes may induce a degree of adrenal insufficiency 

 which contributes to the observed clinical picture. Thus in 

 uncomplicated cases of superficial burns the most characteristic 

 changes occur in the adrenals. 665 These organs are swollen and 

 deep red. On section one may find extensive hemorrhage. 

 The cells are pale and swollen and in a process of hydropic 

 degeneration. The cause of death in extensive burns has not 

 been definitely proven. It is generally assumed that absorp- 

 tion of toxins from the injured skin and from bacterial infec- 



