THE SYMPATHETIC SYSTEM 151 



TREATMENT. 



Except in the very rare cases in which Addison's disease 

 occurs in syphilitics and in which specific treatment is 

 indicated, the treatment is purely symptomatic. 



1. Organo therapy, directed against the adrenal 

 insufficiency is very important. 



Suprarenalin can be used in the same manner as in cases 

 of adrenal insufficiency; the total extract seems preferable 

 either as the fresh gland (of sheep or calf), starting at 

 first with half then a whole gland, or in the form of dried 

 extract in doses of from 0.60 to 0.90 centigrams daily. 



If medication by mouth is counterindicated, by reason 

 of the gastric intolerance, so frequent in Addison's disease 

 it is possible to administer subcutaneously the glycerin 

 extract of the adrenals of sheep in doses of 1 to 5 ccs., di- 

 luted in normal saline (10 to 20 ccs.) to make it less painful. 



It is important, whatever the medication employed, to 

 start in as soon as possible and to keep it up for a long period 

 of time. The results are often only noticeable in many 

 cases several months afterwards. The results are, further- 

 more, far from being constant. Some manifest a real 

 intolerance for organo therapy; they have nausea, vertigo, 

 waves of heat. Glycosuria tremors have been noted after 

 the administration of adrenal extracts in patients with 

 Addison's disease. In others, even when treated at 

 the beginning of the disease, organo therapy is of no value. 

 Others, however, derive considerable benefit from the 

 treatment. Remissions lasting several years have been 

 obtained. In the majority of cases there is simply an 

 improvement of certain symptoms; the blood pressure 

 goes up, asthenia decreases, the gastro intestinal disturb- 

 ances disappear. The pigmentation on the other hand 

 is rarely influenced by this treatment. 



