THE ADRENALS 43 



cause of sudden collapse and death ; it is probably 

 due to some toxaemia which rapidly raises pressure 

 to too high a point for the fragile vessels in the 

 gland to withstand. In the acute infectious 

 diseases of childhood it is often the knock-out 

 blow ; one may always suspect it, if one sees 

 purpura. That fatal affection called black measles 

 almost certainly has this complication. Nothing 

 much can be done, but careful attention to the 

 preceding fever and high pressure may ward it 

 off. Adrenal haemorrhage in adults is certainly 

 rare, but probably in some cases is not diagnosed. 

 The symptoms in a bad case are very severe ; there 

 is great abdominal pain, diarrhoea, sickness, or 

 both, and great collapse, with all the signs of 

 adrenal failure in the heart and arteries. 



Hyperadrenia in middle life and beyond merges 

 into the great subject of arterio-sclerosis. This 

 in all its forms, especially that of hyperpiesis, is 

 preceded by a period of high tension, unsuspected 

 generally, and therefore unmeasured in time. 

 Careful questioning will generally show that the 

 early symptoms have been coming on for months. 

 These are chiefly shortness of breath on exertion, 

 vertigo on stooping, occasional tinnitus, and a 

 feeling of fatigue, mental and bodily, out of 

 proportion to the work done. There is no doubt 



