'278 BENSON A. COHOE 



Bramwell, Rjlleston and others. It is, however, to the pre-clinical sci- 

 entists, especially to the physiologists and pathologists, that the advance 

 in our knowledge of the disease, imperfect as it is in many respects, is 

 in large measure owing. The physiologists, on their part, were stimulated 

 into undertaking investigations directed towards the elucidation of the 

 obscure function of the suprarenal glands, and the epoch-making research 

 of Brown-Sequard in relation to the vital importance of these organs, 

 played no small role in the subsequent formulation of the modern concep- 

 tion of the theory of internal secretion. The later experimental researches 

 of Tizzoni, Abelous and Langlois, Oliver and Schafer and Takamine, and 

 more recently of Elliott, Gley, Stewart, Vincent, Cannon, Hoskins and 

 numerous other investigators have produced many facts of prime impor- 

 tance to our interpretation of the clinical features of the disease, while the 

 anatomical research of Kohn and of Wiesel has had an important bearing 

 upon our conception of the pathogenesis. Although it has not proven pos- 

 sible, as yet, to correlate all of the accumulated facts arising from clinical, 

 pathological, physiological and anatomical investigations, a very consid- 

 erable progress has already been made in that direction. Meanwhile, 

 after the lapse of almost three quarters of a century of painstaking and 

 exhaustive research, from which have arisen many inadequate hypotheses 

 concerning the origin of the malady, the significant fact remains as a 

 remarkable tribute to the scientific acumen of Addison, that his clinical 

 description of the disease embraces almost all that we regard as essential 

 at the present day, and further that his discovery of the association of a 

 decreased function of the suprarenal gland with muscular and circulatory 

 weakness still stands as probably the most important fact known con- 

 cerning the function of this organ. 



Etiology. The disease is rare. Personal observations of the disease 

 by the individual clinician are limited to a few cases, and even in large 

 medical clinics less than one case a year may be noted. Osier remarks 

 that only seventeen cases came under his observation in the United States. 

 It occurs at all ages, in all races, and all climates, but is believed to be 

 more common in the white races, and in Europe. The older statis- 

 tics would seem to indicate that males are more often affected than females, 

 in the proportion of about six to four. In Greenhow's analysis of 183 

 cases, there were 119 males and 64 females, but the statistics of the Bureau 

 of Census for the United States, on the other hand, show that of 320 

 persons dying of the disease during the year 1917, in this country, 174 

 were females and 146 males. Of this number only 5 cases occurred in 

 the colored race. The average annual death rate per 100,000 of the popu- 

 lation for the decade 1900-1910 was 0.45, and the cases were equally 

 distributed between urban and rural districts. As Addison pointed out, 

 it is a disease of middle life, of the third or fourth decade, the majority 

 of cases occurring between the twentieth and the fortieth years. Although 



