336 THE DISEASES OF THE SUPRARENAL APPARATUS 



to a common function, at least in part (Biedl), which fact is also indicated by 

 the previously mentioned relations of the blood-vessels. It is indispensable 

 for the comprehension of diseases of the suprarenals to consider that the two 

 systems for a great part are functionally independent. The higher we go in 

 the classes of animals, the greater become the complexes of the two systems 

 that finally unite to form a single organ, the suprarenal. 



a. Conditions of Hypofunction of the Suprarenal Apparatus 

 i. Addison's Disease 



Definition. In the year 1855 Thomas Addison described the disease that 

 bears his name. The disease mostly develops in the third or fourth decades of 

 life, usually quite insidiously, with adynamia and apathy. To these are added 

 disturbances of the digestive tract (constipation, often alternating with diarrheas) 

 and pigmenting of the skin and the mucous membranes; the patients succumb 

 under a gradually increasing cachexia, not rarely with stormy terminal mani- 

 festations; autopsy almost always shows disease of both suprarenals, mostly 

 tuberculous caseation. Addison's description embraces all the essential 

 features. 



Symptomatology. The disease affects mostly individuals, often heredi- 

 tarily inclined to tuberculosis, who have been weakly from youth. Mostly 

 it is individuals of middle age who are affected, rarely are children or old 

 people affected. Almost always the disease manifests itself in ready fatiga- 

 bility, disinclination for work, and apathy; to these symptoms are sometimes 

 added headaches, poor sleep, sometimes obstinate insomnia, psychical ill- 

 humor and depression, often too, abnormal irritability; further, diminution 

 in memory, noises in the ears, vertigo and commonly fainting attacks, 

 singultus, and rheumatoid pains in the back and in the extremities, sometimes 

 also epileptiform convulsions. Extremely stormy manifestations on the 

 part of the nervous system may, especially in the later stages, make their 

 appearance violent delirium, acute confusion, convulsions, deep stupor, and 

 coma. The symptoms on the part of the digestive tract are very various. 

 The patients complain about pressure in the stomach, eructation, nausea, 

 pyrosis, sometimes vomiting and epigastric pains. In the later stages there 

 are mostly lessening or absence of the hydrochloric acid and ferment produc- 

 tion. Often diarrheas alternate with constipation. The diarrheas may 

 occur in crises with great violence, may be associated with spasms of the 

 calves and may simulate the picture in cholera nostras. In the terminal 

 stages there is often immitigable vomiting. To this may be added ab- 

 dominal pains and constipation; the abdomen is retracted, the abdominal 

 walls are tense, the pulse becomes small, in short, there exists the picture of 

 peritonitis (Ebstein). 



In the later stages the adynamia becomes prominent. Early the pulse is 

 strikingly small and soft, the blood-pressure reduced, the force of the pulse 



