HYPOADEEOTA 319 



a few days in death, although in some instances the course may run for 

 several months, a fact which led Bernard to describe a subacute form of 

 suprarenal insufficiency; (3) The nervous type, in which the main symp- 

 toms may be either convulsions, delirium, or coma, or a typhoid state; 

 (4) Cases of sudden death, in which at autopsy simply a destructive lesion 

 of the glands, usually hemorrhage, has been found; (5) Cases associated 

 with a purpuric eruption or hemorrhages into the abdominal viscera, 

 occurring most commonly in children. This author has pointed out that 

 although the majority of cases of acute suprarenal insufficiency may be 

 classified in one or another of the foregoing groups, many cases are char- 

 acterized by symptoms common to more than one group. 



The occurrence of the syndrome of hypoadrenia, during the course 

 of the various infectious diseases, has been repeatedly described in the liter- 

 ature of recent years. The clinical evidence of altered functioning of the 

 various endocrin organs, resulting from infection, has been sought for 

 by clinicians, and an endocrin factor has come to be regarded as a common 

 cause of the modification of the clinical course of an infectious disease 

 (Hutinel). In the opinion of Pende(a) and others, of all the endocrin 

 glands the suprarenals are most commonly affected in the course of infec- 

 tions. It has long been known that these glands frequently show pathologi- 

 cal alterations as a result of acute infections. Many writers have attrib- 

 uted to the organs a defensive function against the infectious process, but 

 others, including Bernard, have not been able to find any evidence to sub- 

 stantiate this view. 



This form of suprarenal failure constitutes the terminal hypoadrenia 

 of Sajous's classification, or the subacute hypoadrenia of other writers. 

 In some instances, the severity of the symptom complex, with fatal end- 

 ing, conforms with the type of acute hypoadrenia. In the opinion of 

 Sajous(&), this form of the malady results from the exhaustion of the 

 secretory activity of the glands during the early stage of the infectious 

 disease, such exhaustion being probably aggravated by temporary local 

 lesions in the glands. The various clinical symptoms, which have been 

 commonly attributed to this form of suprarenal insufficiency, are, asthenia, 

 hypotension and hypothermia, cardiac weakness and feeble pulse, tach- 

 ypnea, cyanosis; occasionally, anorexia, nausea, diarrhea, fainting spells, 

 syncope or cardiac failure. 



The syndrome has been observed, in different degree, in a great variety 

 of infectious diseases, including diphtheria, typhoid and paratyphoid 

 fever, influenza, pneumonia, bronchopneumonia, malaria, cerebrospinal 

 meningitis, bubonic plague, malignant endocarditis, dysentery, epidemic 

 icterus, scarlet fever, septicemia and tuberculosis. The lesions found in 

 the glands at autopsy may be restricted to a reduction in the cholesterin 

 bodies of the cortex, and a decreased chromaphil reaction, with possibly 

 cellular atrophy and focal necroses, or in other instances, extensive in- 



