THE SYMPATHETIC SYSTEM 139 



lesions are not as extensive or as deep, the clinical 

 phenomena are not as severe and less definite, because 

 they are hidden by the causative disease. 



III. ADRENAL INSUFFICIENCY FOLLOWING VARIOUS 

 FORMS OF INTOXICATION. 



Alimentary poisoning, poisoning by mushrooms, by 

 suffocating gases, by ether and particularly by chloroform 

 (Delbet, Herrenschmidt and Beauvy) can cause adrenal 

 insufficiency by the intermediary of lesions of the 

 suprarenal capsules. 



DIAGNOSIS. 



1. The diagnosis of slow adrenal insufficiency is always 

 difficult. They are particularly liable to be overlooked 

 in cases in which there is no pigmentation, as in the pure 

 cases of adrenal insufficiency. A number of pathological 

 processes have a very similar symptomatology : asthenia, 

 hypotension, gastro intestinal disturbances and anemia 

 are found in pulmonary tuberculosis, latent cancer, certain 

 cases of neurasthenia, certain diseases of the blood as 

 anemia, leukemia, etc. Any morbid process associated 

 with asthenia and hypotension, is indicative of adrenal 

 organo therapy and its adrenal origin can be suspected if 

 there is some improvement by this type of medication. 



2. When symptoms of acute insufficiency occur during 

 the course of an infectious disease, the diagnosis is easier. 

 During convalescence from diphtheria, the symptoms are 

 as a rule so definite that no hesitancy is permitted. In 

 the course of typhoid fever, however, the signs are often 

 hidden by the primary disease. Typhoid myocarditis 

 presents circulatory symptoms: tachycardia and hypo- 

 tension analogous to those of an inflammation of the 

 adrenals. The presence of the white line, of abdominal 

 pain, vomiting, and pallor are in favor of an adrenal 



