THE SYMPATHETIC SYSTEM 135 



A. SLOW SUPRARENAL INSUFFICIENCY. 



It is noticed in the course of chronic affections of the 

 adrenals, which cause a slow decrease in the functions 

 of the glands. The most definite type is Addis on 's 

 disease, which we will describe very shortly, but which 

 must be given a place here. If this disease is a mixed 

 syndrome of adrenal insufficiency associated with an 

 irritation of the sympathetic, certain types which have 

 been described as abortive cases of Addison's disease, 

 because of the lack of pigmentation, are really pure cases 

 of adrenal insufficiency slowly evoluting and which only 

 differ from the acute type by their duration, which is 

 anywhere from 1 to 3 years. 



B. ACUTE SUPRARENAL INSUFFICIENCY (syndrome of Claude Bernard.) 



It corresponds to a sudden decrease or suppression of 

 the adrenal functions. 



While slow adrenal insufficiency is due to a decrease, 

 ordinarily progressive, of the adrenal functions, so that 

 the symptoms take a long time to develop, acute insuffi- 

 ciency is due to the sudden suppression of the glandular 

 functions following the destruction of the gland. It gives 

 rise to severe symptoms which are rapidly fatal. It 

 occurs sometimes in individuals apparently in good health, 

 or in the course of an infectious disease, or again following 

 a slowly evoluting case of which it will be the ending. 



The syndrome manifests itself under three different forms : 



(A) ABDOMINAL TYPE, (a) The symptoms develop 

 suddenly with abdominal pains which are severe, diffuse 

 and accompanied by incoercible vomiting, and even severe 

 diarrhea. These gastro intestinal symptoms are followed 

 by cramps. The patient is covered with a cold perspira- 

 tion and the extremities are cold; the pulse is small, rapid 

 and feeble. The temperature is subnormal and the 



