160 THE INTERNAL SECRETIONS—1920 
more she worried, the worse she felt. July 15th, 1920, 
blood and spinal fluid showed negative Wassermann 
tests. The use of adrenalin, by mouth, served to homo- 
stimulate the adrenals and cause the disappearance of 
all symptoms, before the blood and spinal fluid tests 
were made. 
The effect of focal infection upon the activity of the 
adrenals is nicely shown in the following case: An old 
man, age 70, was seen a year ago with Dr. J. R. Perry, 
of Sherman, California. His blood pressure had been 
elevated to 196 mm. The doctor found some pus teeth, 
and advised their removal. This was done, and in two 
weeks blood pressure fell to 136 mm., systolic, but at the 
same time he developed “spells” lasting ten to fifteen 
seconds, during which time he apparently was semi- 
conscious. These spells were always preceded by a 
chewing movement of the face and jaw muscles. Jack- 
sonian epilepsy was suspected by the attending physi- 
cian. Systolic blood pressure was now 136 mm. recum- 
bent, but was only 100 mm. erect. Sergent’s white line 
was also present. Adrenal hypofunction was my diag- 
nosis. I reasoned that the toxins from the pus teeth 
had served to irritate and stimulate the adrenals; when 
these toxins were no longer formed, the excessive stim- 
ulation ceased, and there was a depression following. 
Adrenal gland with thyroid, spermin and calcium were 
given, with the prompt recovery and return to ranch 
life in about a month. 
SEVERE, ACUTE HYPOADRENIA 
In the acute cases there has been either of the fol- 
lowing: (a) violent injury, (b) severe hemorrhage, 
(c) overwhelming infection and intoxication, (d) se- 
vere psychic shock or, finally, (e) acute acidosis. I am 
convinced that many deaths on the operating table are 
due to acute hypoadrenia, overlooked by the surgeon. 
I wish to relate my experience with a case seen with 
