THE SYMPATHETIC SYSTEM 153 



that a decrease in the adrenal secretion plays an important 

 part in the progress of tuberculosis. 



2. IN PATIENTS SUFFERING FROM ASYSTOLE, accord- 

 ing to Josue, adrenal insufficiency appears as the terminal 

 ending of asystole. To the signs of cardiac insufficiency 

 are added: asthenia, hypotension, the white line. At 

 autopsy, the atrophy of the adrenals contrasts with the 

 hypertrophy of the myocardium. 



3. IN NEPHRITICS, the syndrome of adrenal insuffi- 

 ciency and even the syndrome of Addison's disease is 

 sometimes the ending of this disease. Cachexia, pigmen- 

 tation and particularly hypotension, then follows a marked 

 hypertension which has lasted months or years (Cas- 

 taigne). It looks as if the decrease in the adrenal function 

 was due to a previous period of hyperf unction. 



4. Mild adrenal insufficiency in post operatives or preg- 

 nant women. Certain symptoms of operative shock which 

 manifest themselves by small, feeble pulse or acute dila- 

 tation of the stomach characterized by abundant vomiting, 

 and even hemorrhages with tendency to collapse can be 

 traced to an adrenal insufficiency, for these symptoms 

 will improve promptly under suprarenalin. The same is 

 true in certain cases of vomiting of pregnancy which are 

 cured by adrenal organo therapy (Sergent and Lian). 



5. ADRENAL DEBILITY. Adrenal debility (Sergent) 

 is very closely related to mild insufficiency. It can be 

 congenital and thus explain the physical and psychic state 

 of certain children; slow, apathetic, always tired, ema- 

 ciated, having a low blood pressure and which are greatly 

 helped by organo therapy. 



It may be acquired following an infection having in- 

 volved the adrenals. Patients recovering from typhoid or 

 severe scarlet fever are for a long time asthenic, with a 



