310 BENSON A. COHOE 



Owing to thp frequency of tuberculous lesions in the suprarenals in 

 this disease a few clinicians have attempted to treat the condition by tuber- 

 culin injections. Beneficial results have been recorded by a few observers. 

 Briinecke has recently noted a marked improvement following the use 

 of partial antigens in a case of acute Addison's disease following influenza. 

 Experience has shown, however, that the use of tuberculin in Addison's 

 disease is at times followed by alarming symptoms, which, it has been 

 suggested, may be due to a local reaction in the region of the suprarenals, 

 resulting in acute insufficiency of the glands. It is obvious that if tuber- 

 culin be employed therapeutically, it should be administered with cau- 

 tion. In other rare cases of the disease syphilitic lesions have been found 

 in the glands, and in cases of Addison's disease, in which the Wassermann 

 reaction is positive, anti-luetic treatment is indicated. 



It seems not improbable that future metabolic studies in this disease 

 may enable the clinician to influence the course of the disease by dietetic 

 measures. Some attempts have already been made in that direction fol- 

 lowing the observation of the low glycogen of the liver in animals deprived 

 of their suprarenals, as well as of the presence of a hypoglycemia in pa- 

 tients with Addison's disease. Porges has observed favorable results, by 

 increasing the carbohydrates (especially of levulose) of the diet, in a 

 number of patients. Grote treated a case with suprarenal extract and 

 the administration of 100 gms. of sugar daily, noting a rapid improve- 

 ment, gain in weight, disappearance of the pigmentation of the skin, and a 

 rise in the blood sugar content. Pitres and Gautrelet also found the use 

 of glucose to be followed by a material improvement in the asthenia. 



Sooner or later in the disease, apart from any efforts to influence the 

 course by glandular therapy, symptomatic treatment becomes imperative. 

 Due to the fact that tuberculosis is so frequent a concomitant of the dis- 

 ease, both in the suprarenal glands and in other foci in the body, with 

 pulmonary lesions present in a large proportion of the cases, the advocacy 

 of a general anti-tuberculous regime of treatment is well founded. Es- 

 pecially should the importance of rest, even in the early stages, be im- 

 pressed upon the patient, and the avoidance of undue physical exertion, 

 since instances of sudden death have been known to. follow severe effort. 

 Boinet reported seven such cases. In acute forms of the disease, and in 

 all advanced cases, absolute rest in bed is necessary, and, indeed, usually 

 obligatory, the patient becoming unable to rise. In such cases, pro- 

 longed examination by the attending physician should be avoided. The 

 gastrointestinal disturbances often prove troublesome. The nausea and 

 vomiting may frequently be relieved by gastric lavage. Constipation should, 

 if possible, be avoided by dietetic measures, or only the mildest laxatives 

 employed. The use of drastic cathartics in this disease is strongly contra- 

 indicated, since fatal collapse has not infrequently followed such purging, 

 a fact to which Greenhow first called attention. For controlling diarrhea 



