306 BENSON A. COHOE 



Adams' series of 97 cases, improvement was observed in 33 instances and 

 permanent relief (cure?) in 16. Sajous(a) has supplemented this series 

 to include 120 cases, noting marked improvement in 36 cases, and perma- 

 nent benefit in 25. These results have been contrasted with the figures 

 of Lewin, who had previously reported a series of 800 cases treated by 

 methods other than suprarenal therapy, with instances of improvement in 

 only 28 cases and of cure in 5. Several observers have recorded a de- 

 crease in the pigmentation following glandular therapy, an effect which 

 has been contrasted with the observing of a rapid return of the bronzing, 

 in some instances, when gland therapy was stopped. In a case re- 

 ported by Osier, the pigmentation cleared up, along with the other symp- 

 toms, the patient dying subsequently from an acute infection, not appar- 

 ently associated with the suprarenal disease. Other observers have de- 

 scribed a gain in weight following suprarenal gland administration, Wei- 

 gall recording a gain of 56 pounds in about three months, but the meta- 

 bolic studies of Pickardt and Kaufmann have demonstrated an increased 

 nitrogen loss following such therapy. Quincke has recently reported two 

 cases of cure in patients with Addison's disease, by the administration of 

 suprarenal glands, and has suggested that in these patients a diminished 

 function of the glands, without anatomical lesions, the result of under- 

 nourishment, and faulty environment during the war, was the probable 

 etiological factor. In the purely functional types of Addison's disease 

 a beneficial result from glandular therapy is quite readily conceivable. 

 Unfortunately such instances are rare. 



Various preparations of the suprarenal glands from different animals 

 were employed by the earlier clinicians in this form of therapy, includ- 

 ing the fresh glands, aqueous or glycerin extracts of the glands, tinctures, 

 partially cooked, or desiccated glands. The suprarenals of the sheep have 

 been most commonly used. The mode of administration, at first, was 

 by subcutaneous injection, but following the observation of Oliver and 

 Schafer, that the activity of the gland was not destroyed by hydrochloric 

 acid and pepsin in vitro oral administration, became quite general. More 

 recently, with the discovery of the active principle of the medulla by 

 Oliver and Schafer(a), and the isolation of the same by Takamine(o.), 

 clinicians have frequently used this purified active principle (epinephrin) 

 in preference to the administration of the extract of the whole gland, 

 some authorities considering it more correct physiologically to administer 

 a substance of known strength. It has been employed both orally and 

 hypodermically, but the results obtained have proven even less encourag- 

 ing than with the use of the whole gland extract. 



As a result of animal experimentation, a considerable number of 

 data have been obtained concerning the pharmacological action of the 

 gland substance, and of the active principle. Foa and Pellacani, among 

 the earlier investigators, succeeded in producing death in a day in animals, 



