.302 BENSON" A. COHOE 



lymph follicles at the base of the tongue, hyperplasia of the entire pharyn- 

 geal ring, lyniphoid growth in the nose, enlarged lymph glands in the 

 cervical, axillary and inguinal regions, enlarged spleen, persistent thymus, 

 together with anomalies of the genitalia and of the secondary sexual char- 

 acteristics, and of the distribution of body hair, constitutes corroborating 

 evidence of the possible presence of this condition. A study of the blood 

 picture may also prove of value since a mononucleosis with an absolute 

 reduction of the neutrophilic leucocytes, and occasionally an eosinophilia, 

 may occur in status thymicolymphaticus. 



We have, as yet, no reliable test for hypofunction of the suprarenal 

 glands, but a few suggestions have been made concerning procedures to 

 determine the presence of suprarenal deficiency in the suspected cases of 

 the disease. Grunbaum has advocated the use of suprarenal extract as 

 a diagnostic aid. According to this writer, in cases of hypotension, the 

 administration of 3 grains of the extract for three days will cause a rise 

 in blood pressure. If a rise of more that 10 mm is found, he regards it as 

 good evidence that a case of hypotension with pigmentation is one of 

 genuine Addison's disease. Other writers have advised the study of the 

 blood-sugar content since there is some evidence to show that a hypogly- 

 cemia exists in this disease. The estimation of the sugar tolerance, and 

 the determination of the absence or the presence of a glycosuria, follow- 

 ing epinephrin injection may throw light upon obscure cases in the fu- 

 ture. Several observations seem to indicate that a high sugar tolerance, 

 and an absence of glycosuria after epinephrin injection, are characteristic 

 features of the disease. Since the lesion in the suprarenals is most com- 

 monly tubercular, the tuberculin test has been frequently employed as a 

 diagnostic measure. Either the ophthalmic, cutaneous, or subcutaneous 

 tests may be used, but with a positive reaction, the probability of tubercu- 

 lous foci in other parts of the body must be considered, and it should 

 be recalled that the subcutaneous injection of tuberculin has occasionally 

 evoked alarming symptoms in patients with Addison's disease. 



The vasomotor skin reflex, or "white line" (ligne blanche surrenale) 

 of Sergent(fr) is found present in many patients with Addison's disease, 

 and should be looked for in all suspected cases. The test is made by strok- 

 ing the skin, preferably of the abdomen, with a blunt object, or simply 

 the finger tip. After about half a minute, a pale line or band appears, 

 gradually becoming more distinct and persisting for from 1-3 minutes. 

 According to Sergent this phenomenon indicates a suprarenal insuffi- 

 ciency, but other observers attribute to its presence only a relative diag- 

 nostic importance, regarding it as by no means pathognomonic of this 

 condition. 



While our present diagnostic armamentarium is sufficiently developed 

 to permit the making of a clinical diagnosis of Addison's disease in a pa- 

 tient, especially in the outspoken cases, our methods of investigation are 



