ADDISOX'S DISEASE 309 



of the 1:1000 solution. Some authorities have advised the giving of 

 epinephrin by mouth, but such oral administration is mainly ineffective, 

 as much as 20 mgm. a day causing no special manifestations ( Vincent (/)). 

 A few observers have reported beneficial results from the use of the drug in 

 Addison's disease but frequent warnings have been made against the use 

 of large doses. The prolonged usage of epinephrin in the treatment of the 

 disease is strongly contraindicated, especially in advanced cases, and in 

 aged individuals with arterial changes. Boinet(t) has reported sudden 

 death in two patients following the injection of small doses. Daland ob- 

 served cardiac dilatation following toxic doses. It is believed that supra- 

 renal apoplexy may be the cause of death, at times, following epinephrin 

 injection. Arnstein and Schlesinger have recently warned against the 

 use of the drug in elderly persons, having observed that in such individuals, 

 following a small dose, the initial rise of blood pressure is followed by a 

 sharp fall and a slowing of the pulse; also that in the presence of 

 coronary sclerosis, severe attacks of stenocardia may be produced. Elliott 

 regards the unfavorable symptoms, at times produced, as mainly due to 

 poisoning of the tissues by quantities of epinephrin exceeding that suffi- 

 cient for physiological stimulation. 



The general conclusions which may be derived from reports of glandu- 

 lar therapy, in this disease, are that only in the earlier stages may any 

 marked degree of improvement be expected, and that in the later stages 

 no beneficial result is likely to occur ; further, that in the advanced cases 

 great care should be exercised in the administration of either the gland 

 substance or of the active principle. 



Quite recently some observers have advocated the use of pituitrin, 

 in conjunction with epinephrin, on account of its pressor effect. The 

 reports, so far, do not indicate that such combination of pressor prin- 

 ciples is of greater therapeutic value than the administration of epinephrin 

 alone. 



Some consideration has been given by clinicians to the feasibility 

 of a surgical treatment of the disease, by extirpation of the diseased gland. 

 Cure, in such a manner, has been reported by Oestreich, who removed 

 a tuberculous tumor of the suprarenal. The syndrome of the disease 

 was incomplete in his case, however, and many observers have doubted 

 the diagnosis. There appears to be no authentic instance of recovery 

 following operative treatment in genuine cases of Addison's disease. In 

 forms of the disease in which a tumor can be recognized exploratory 

 operative procedure is doubtless justifiable. Almost always, however, the 

 lesion in the suprarenal in this disease is bilateral and extirpation of both 

 glands is known to be invariably fatal. Furthermore, as Wiesel(d) has 

 demonstrated, the extramedullary chromaphil tissue is commonly in- 

 volved. Both of these factors are serious obstacles towards any success- 

 ful operative form of treatment. 



