316 BENSON A. COHOE 



rule, within a few days. In the subacute form the symptoms are less 

 severe and the course may be prolonged for several weeks or months. The 

 chronic type includes atypical cases (formes frustes) of Addison's disease, 

 and other chronic forms arising from a purely functional inadequacy of 

 the gland (faulty development). In this country Sajous(a), as a result of 

 extensive study of states of hypofunction of the suprarenal glands, has pre- 

 sented the following classification: (1) Functional hypoadrenia, a form 

 in which the glands are functionally deficient, due to faulty development, 

 or debilitating influences, such as fatigue, starvation, old age, etc., in 

 the absence of organic lesions; (2) Progressive hypoadrenia, or Addison's 

 disease, a form in which the function of the glands is progressively im- 

 paired by organic lesions; (3) Terminal hypoadrenia, a form occurring 

 as a more or less late complication of infectious diseases and toxemias, 

 owing to exhaustion of the secretory activity of the glands in the earlier 

 stages of the causative disease. 



The symptom-complex of the various forms of hypoadrenia varies 

 greatly in the individual cases, a fact which has rendered a satisfactory 

 classification of the types difficult. The acute forms have been somewhat 

 more easily circumscribed, but even in this group there is a wide varia- 

 tion in the symptomatology, and certain types within this group have 

 been described, depending upon the dominant symptoms, such as the 

 pseudo-peritoiiitic type of Ebstein, and the pseudo-meningitic type of 

 Sergent. 



The acute forms of hypoadrenia are characterized by a sudden onset, 

 and run, in the majority of cases, a rapidly fatal course, death ensuing 

 within a few days. The symptom-complex varies with the nature and 

 extent of the pathological changes occurring in the glands, and, in some 

 cases, with the degree of the involvement of the sympathetic nervous sys- 

 tem. The symptoms which have been found associated with this condi- 

 tion are, in general, severe pain in the lumbar region, or epigastrium, or 

 other parts of the abdomen, severe gastro-intestinal disturbances, as vomit- 

 ing, or diarrhea or both, abdominal tenderness, meteorism, marked as- 

 thenia, cardiac weakness and feeble pulse, arterial hypotension, hypo- 

 thermia (sometimes preceded by pyrexia), cold sweats, cyanosis, collapse, 

 convulsions, delirium, coma, exitus. Of all the foregoing symptoms as- 

 thenia, in varying degree, is the most constant in occurrence. In many 

 cases a purpuric rash has been noted, a phenomenon which Dudgeon re- 

 gards as analogous to the melanoderma of the Adclisonian syndrome but 

 which the majority of writers attribute to a general visceral hemorrhagic 

 tendency. 



The anatomical changes in the suprarenal glands, which have been 

 most commonly found associated with the clinical syndrome of acute hypo- 

 adrenia, are mainly hemorrhage into the gland substance, and inflam- 

 matory changes (the so-called suprarenalitis), with softening and necrosis. 



