ADRENAL HYPOFUNCTION 161 
Dr. B. G. Pinkerton of Los Angeles. In August, 1918, 
D. R., age 18, one Monday night suddenly developed a 
fever of 104, which by Tuesday noon subsided to 97 de- 
grees. The boy was delirious continuously from the 
onset. Tuesday afternoon he began to vomit and have 
involuntary urination and defecation. One consultant 
suggested an early tuberculous meningitis; another 
suggested thrombosis of the lateral sinus, or perhaps a 
brain abscess. Wednesday morning brought no change. 
At 9 A. M. Wednesday I saw the patient and found the 
above condition, with temperature 97 degrees, pulse 
140, systolic blood pressure 90 mm. The urine con- 
tained both albumin and casts, with plenty of acetone. 
My diagnosis was acute adrenal exhaustion from the 
acidosis. Adrenalin-chloride and Kalak water were 
given by mouth, with a solution of bicarbonate of soda 
and sodium chloride by rectum, by the Murphy drip 
method. This regimen soon changed the whole picture. 
By 5 P. M. the pulse was 110, the systolic pressure 100 
mm., with a cessation of the vomiting and lessening of 
the delirium. The next morning the pulse was 76, sys- 
tolic pressure was 120, temperature 98.6, and the boy 
wanted to go home. If that boy had been anesthetized 
and an operation performed for sinus thrombosis, what 
chance would he have had for recovery? 
THE RELATION OF THE MINERAL METABOLISM 
The subject of acidosis is closely allied to demineral- 
ization. The adrenals, and, in fact, all the ductless 
glands, must have the proper amount of the proper 
mineral salts in the plasma for their perfect function- 
ing. Hypoadrenia, then, also means demineralization, 
and adrenal feeding will not accomplish much unless 
we supply these minerals also. Stheeman (14) has 
shown, using the method of De Waard, that the calcium 
content of the blood is low in neuroses of the vegetative 
nervous system, universal asthenia, and tuberculosis; 
