298 BENSON A. COHOE 



ing matter (uMiematoporphyrin), determined spectroscopically. Such 

 findings as taurocholic and hippuric acids (Leva), and of increased vola- 

 tile fatty acids (Gerhardt and Beichardt), and of the appearance of cer- 

 tain amino-acids (Ewald), have not received general confirmation. Wolf 

 and Thacher found an absence of creatin in one case. In a single instance 

 in which the renal function test (phenolsulphonephthalein) was recorded 

 (Daland), normal readings were obtained. 



Gastropathy. The gastric analysis, as a rule, shows no abnormality 

 characteristic of the disease. Hyperacidity has been noted, especially in the 

 earlier stages, while in the advanced stages, the acidity is usually di- 

 minished. In a series of cases, in various stages, from hospital records, 

 the free hydrochloric acid reading was found to range from 15-34^ and 

 the total acidity from 30-46. An absence of free hydrochloric acid and 

 of pepsin has been observed in only a few instances. 



Metabolism. Owing possibly to the rarity of the disease, compara- 

 tively few metabolic studies have been undertaken, and our knowledge 

 of the total metabolism is, as yet, somewhat meager. A loss of weight, 

 of greater or less degree, usually accompanies the disease, but extreme 

 emaciation is rare. The earlier studies of protein metabolism were con- 

 fined mainly to an investigation of the nitrogen balance, and to an estima- 

 tion of the effect of the administration of adrenal gland substance on the 

 protein metabolism. According to Richter the protein metabolism is not 

 appreciably altered. Senator's investigations led him to conclude that 

 the administration of the gland substance produced an increase in body 

 weight, and a retention of nitrogen, with a slight calcium loss. But Kauf- 

 mann and Pickardt, on the other hand, found an increased nitrogen loss 

 during the administration of the gland substance. Vollbracht and Eiselt 

 have reported an increased phosphoric acid elimination in the disease, 

 which Richter has attempted to explain on the assumption of an increased 

 destruction of bone substance. The investigations of Leva, and of Wolf 

 and Thacher, have adduced some evidence to show that the protein metab- 

 olism, especially the endogenous protein metabolism, as indicated by the 

 creatinin and uric acid output, is lower than normal. Wolf and Thacher 

 further observed that the desami dating capacity of the patient and 

 his capacity to transform sulphur into sulphuric acid were abso- 

 lutely comparable to that of normal persons. Marchetti and Stefan- 

 elli have advanced the opinion that the oxidative capacity of the 

 organism is diminished in Addison's disease, basing their theory upon 

 the manner in which the patients react to a diet low in nitrogen and caloric 

 value. Loffler, in a case of Addison's disease, observed a decrease in the 

 used oxygen and in the excreted carbon dioxid, and a low respiratory 

 quotient. There is some evidence to show that a hypoglycemia, and a 

 high sugar tolerance, is characteristic of the disease. Forges and others 

 have reported hypoglycemi^ in patients with Addison's disease, Eppinger, 



