ADRENAL HYPOFUNCTION 155 



balance instead of using measures designed only to 

 stimulate or suppress the activity of the sympathetic 

 nervous system. 



THE ROUTINE STUDY OF HYPOADRENIA 



This brings me to the real subject of adrenal hypo- 

 function as seen in the every-day practice of medicine. 

 These are not necessarily cases of Addison's disease, 

 but the common conditions which unquestionably have 

 an adrenal basis. Many of the more pronounced cases 

 come complaining, among other things, of weakness; 

 but how are we to know objectively that they are weak? 

 The answer is : Determination of the blood pressure. 

 In the normal, the systolic blood pressure is some 

 4-10 mm. higher in the standing or erect position than 

 It is in the recumbent position. This is due to the abil- 

 ity of the splanchnic vasomotor mechanism to overcom- 

 pensate for the hydrostatic effects of gravity. 



If we examine the splanchnic veins we find they are 

 devoid of valves, and in this way differ from the veins 

 of the extremities. The strength of the splanchnic 

 veins is dependent upon the quality of their nerve-tone, 

 for any muscle is weak in proportion to the weakness 

 of its nerve-tone. If the nerve-tone is weak, the vein 

 wall is weak and cannot compensate the effects of grav- 

 ity. Hence, the drop in systolic blood pressure in the 

 erect position as compared to the recumbent position. 

 The splanchnic nerves are controlled by the adrenal 

 system; therefore, weak splanchnic veins means weak 

 splanchnic nerves and weak adrenals. 



Hill (3) found that anything that weakens the 

 splanchnic vasomotor mechanism interferes with com- 

 pensation. Sewall (4) has shown that persons in whom 

 there is an excessive gravitation of blood to the lower 

 limbs and splanchnics, are physically weak, nervously 

 unstable and frequently suffer from headache and dizzi- 

 ness in the erect position. Schneider (5) utilizes 



