13 2 JOHN T. HALSEY 



others spontaneous remissions, which have simulated cure, have been 

 attributed to the treatment employed. However, such absolute skepticism 

 does not appear justified, although in estimating the significance of ap- 

 parent benefit from organotherapy, it is wise to remember that Addison's 

 disease is almost invariably associated with and caused by tuberculosis. 

 It is, therefore, in many cases difficult or impossible to differentiate be- 

 tween improvement due to the suprarenal therapy and that resulting from 

 the cure or amelioration of the tubercular conditions present. 



While the favorable effects reported have followed the administration 

 not only of extracts of the whole gland, but also that of epinephrin itself, 

 extracts of the whole gland seem, at any rate in some cases (Daland, 

 Quincke), to be more effective than the pure alkaloid. Most observers 

 have found that in this disease administration of the drug by mouth is 

 as efficient as, or superior to, its administration subcutaneously. The 

 efficient dosage varies within very wide limits. In Bate's case % grain of 

 suprarenal gland daily was sufficient, while in Suckling's case benefit 

 resulted from gradual increase of the daily dose from 10 grains to 175 

 grains. In Daland's case 90 grains of suprarenal extract, thrice daily, 

 caused mental and physical weakness, irritability, and insomnia, which 

 disappeared when the dose was diminished, maximum benefit being secured 

 from 35 grains thrice daily. 



Attempts to overcome the effects of destruction of the suprarenals by 

 transplantation of the glands have not been lacking. Transplantation of 

 the glands of different species of animals into human beings has brought 

 no favorable results, and in some instances has terminated disastrously, 

 death sometimes following within a few days, Morton reported successful 

 transplantation of a human suprarenal gland in a case of Addison's disease 

 with subsequent marked improvement. 



Acute Suprarenal Insufficiency (Acute Hypoadrenia), It is the 

 opinion of various authors that in numerous patients suffering from a 

 variety of diseases a condition of suprarenal insufficiency develops, which 

 may or may not be accompanied by demonstrable pathologic lesions of 

 these glands. In this country Sajous, and in France Sergent (a) (&) have 

 been strong advocates of such views. In the opinion of these and many 

 other authors, suprarenal insufficiency develops very frequently in the 

 course of acute infections, during general anesthesia (especially if very 

 prolonged), and also as a result of extremely violent and prolonged muscu- 

 lar effort (for example, in soldiers during the recent great war). 42 



In the circulatory failure of infectious disease, suprarenal preparations 



42 That post mortem the suprarenal glands .under such conditions frequently show 

 pathologic changes cannot lie denied. With our present defective knowledge of the 

 function of these glands, and with the uncertainty whether its hormone normally 

 exerts any important influence on the circulation, it is at least doubtful whether 

 suprarenal insufficiency is (as believed by these clinicians) the sole, or even the chief, 

 cause of the circulatory failure which so often develops in these cases. 



