304 BENSON A. COHOE 



of the opinion that recovery is conceivable, in tuberculous (jases, if the 

 primary lesion in the suprarenal heals, and sufficient intact cortical tis- 

 sue, and extra-suprarenal chromaphil tissue, remain to carry on the func- 

 tion of the gland. 



Treatment. The high mortality in this disease affords a criterion 

 of the inefficacy of any form of therapy yet devised. Following Addison's 

 discovery of a destructive lesion of the suprarenal glands as the causative 

 factor, clinicians attempted to effect a so-called "causal" or "substitution" 

 therapy, with the hope of replacing the perverted function of the glands. 

 Two possible methods of attaining this appeared rational, either the graft- 

 ing of healthy suprarenal glands into the tissues of the patient, or the ad- 

 ministration of the gland substance itself. Unfortunately, neither form 

 of substitution therapy has as yet proven efficacious. It has not been pos- 

 sible, so far, to produce a functioning suprarenal graft in man, and while 

 a, certain number of cures have been reported, following the use of supra- 

 renal gland substance, this method of treatment has in no measure yielded 

 the brilliant results obtained by the administration of thyroid extract in 

 c&chexia thyreopriva. 



The problem of a glandular therapy in Addison's disease is beset with 

 many difficulties, in the fact that very rarely are we dealing with the con- 

 dition of a purely functional disturbance of the suprarenal glands. As- 

 sociated with the hypofunction are pathological changes in the gland sub- 

 stance and adjacent tissues (sympathetic nervous system and extramedul- 

 lary chromaphil tissue), the nature and extent of which cannot be de- 

 termined. A further obstacle lies in our imperfect knowledge of the func- 

 tion of the suprarenal gland as a whole, or of its component parts (inter- 

 renal and chromaphil systems). Indeed, modern physiological investiga- 

 tions have not adduced any reliable evidence of the presence in the blood 

 of any secretion of the suprarenal glands under ordinary peaceful condi- 

 tions of life. It is evident, that for the present, any form of suprarenal 

 therapy must remain purely empirical. 



The literature of Addison's disease has, however, become filled with 

 the records of experiences with suprarenal gland therapy. The evidence 

 is conflicting, and frequently misleading, since an impartial judgment of 

 the final result is rendered difficult by the fact that remissions are of com- 

 mon occurrence in the disease, in the absence of any therapeutic measure. 

 In general, failure has been more commonly reported than benefit from 

 this form of therapy. A number of writers have endeavoured to explain 

 these numerous failures. Bramwell has assumed, in such cases, an in- 

 volvement of the sympathetic system by adhesions and irritation. The 

 cases which improve on suprarenal treatment, he believes., are those in 

 which only a glandular inadequacy is present. Shaw describes the diffi- 

 culty of securing an adequate absorption of epinephrin as a possible cause 

 of failure. Sajous(a) regards the unfavorable results obtained as due in a 



