134 ENDOCRINE GLANDS 



dria. In the latter cases they are usually limited to a 

 special spot corresponding to the extremity of the 12th 

 rib (Martineau's point). Sometimes they radiate to the 

 thorax and shoulders. Whether continuous or intermit- 

 tent, they are generally exaggerated by motion and are 

 sometimes so severe that they cause the patients to cry 

 out. In certain acute cases of adrenal insufficiency, the 

 pains are generalized and the patient complains of stab- 

 bing pains in the limbs simulating the muscular cramps 

 of cholera. 



4. GENERAL DISTURBANCES. These disturbances of 

 toxic origin are very variable. They consist of a psychic 

 asthenia characterized by a half conscious state, or pros- 

 tration. Sometimes they are quiet, at others they have 

 nightmares, arid even delirium. Later on coma sets in. 



Among these nervous phenomena, some have a sudden 

 onset: they are manifested by an encephalitis accompanied 

 by convulsions, cerebral stimulation, delirium and are 

 ended by a deep prostration which terminates in death. 



5. GENERAL SIGNS. The temperature is normal or 

 subnormal and the patients complain of feeling chilly. 

 The anemia is often quite marked (decrease in both red 

 cells and hemoglobin) and is associated with buzzing of 

 the ears and vertigo. 



The urines are decreased in quantities, sometimes con- 

 tain albumen and are very toxic. Finally, loss of weight 

 and emaciation, particularly of the muscles, is the rule. 



CLINICAL FORMS. 



The signs of suprarenal insufficiency can be divided into 

 two main groups: chronic and acute suprarenal insuffi- 

 ciency. Between these two types can be found many 

 intermediary forms. 



