308 BENSON A. COIIOE 



in some instances, the action varies with the dosage. Another fact, which 

 the physiologists have recently demonstrated, and which should be borne in 

 mind in the efforts of clinicians to effect a "casual" therapy, is that a true 

 epinephrinemia probably never exists under ordinary conditions, and that 

 the suprarenal deficiency in this disease is not, so far as we know, de- 

 pendent upon an epinephrin deficiency. In our present lack of knowledge, 

 therefore, it would appear more rational to administer the whole gland 

 substance rather than epinephrin in the treatment of the disease (Vin- 

 cent^)). Until cur information concerning the function of the glands, 

 and the pathogenesis of the disease, becomes more exact, the treatment by 

 means of the gland substance must remain purely empirical, but that 

 such therapy is legitimate, and should be attempted in every case, is the 

 opinion of most authorities. 



The preparation most commonly used at present is the desiccated 

 gland substance (Glandul suprarenales siccce, U. S. P.), prepared from 

 the suprarenals of the sheep, in powdered or tablet form, one grain repre- 

 senting approximately five grains of the fresh gland. The average official 

 dosage is about 5 grains (0.32 gin.) thrice daily, given orally, but the in- 

 formation concerning the optimum dosage in the treatment of Addison's 

 disease is meager. Good results have been reported from both smaller 

 and larger doses than the average. Bate recorded great improvement 

 with the administration of 1/12 of a grain (0.005 gm.) thrice daily while 

 Daland observed the best results to follow a dosage of 35 grains (2.2 gm) 

 thrice daily. Sajous(a) believes that the temperature and blood pressure 

 readings may afford an index of the optimum dose in the individual case, 

 and that the aim in treatment should be to adjust the dosage to the needs 

 of the organism. This author advises the use of 3 grains (0.2 gm.) thrice 

 daily, if the blood pressure and temperature are considerably below normal, 

 increasing the close if necessary until the pressure and temperature be- 

 come normal, and regulating the dose, thereafter, to maintain this level. 

 Some observers maintain that the oral administration of large doses of 

 the extract fails to produce any noticeable rise of blood pressure, but Griin- 

 baum states that although such failure usually occurs in normal subjects, 

 in patients with Addison's disease, an elevation of the blood pressure may 

 be produced by oral administration. It should be recalled that untoward 

 effects have -sometimes followed the therapeutic use of the gland extract. 

 Adams mentions an alarming collapse in two patients treated by Affleck 

 with suprarenal gland extract. Boinet(/?) observed marked excitement, 

 tremor and insomnia in a patient treated with a glycerin extract of the 

 whole gland. Daland found that toxic doses of the extract (90 grs. t.i.d.) 

 produced mental and physical weakness, irritability and insomnia, which 

 disappeared when the dose was diminished. Death was attributed to 

 the use of gland preparations in several instances in Adams' series. 



Epinephrin is usually administered hypodermically, from 5-10 minims 



