HYPOADKENIA 325 



In the course of the infectious diseases, with a sudden lowering of the 

 blood-pressure, and a fall in the temperature, marked prostration, chilli- 

 ness and possibly anorexia, nausea, or diarrhea, the probability of supra- 

 renal involvement should be kept in mind. The " white line" of Sergent 

 may be present in such cases and offer an aid in diagnosis, although this 

 phenomenon is by no means pathognomonic of suprarenal insufficiency. 



In suspected cases of functional hypoadrenia, the study of the general 

 constitution for evidence of congenital inferiority in the chromaphil sys- 

 tem* and other endocrin glands, and particularly a search for signs of 

 status thymicolymphaticus may assist in arriving at a conclusion. 



There is no specific therapy for hypoadrenia. The use of epinephrin, 

 and of the gland extract, has been recommended by many clinicians, some 

 of whom have reported encouraging results, in various forms of hypo- 

 adrenia. In the acute type, with destructive lesions in the glands, such 

 therapy offers little hope of ameliorating the symptoms. Sajous(o-) has 

 recommended the administration of physiological saline solution, intra- 

 venously, in the emergency cases of suprarenal hemorrhage, along with the 

 use of such drugs as amyl nitrite or nitroglycerin. In the form of hypo- 

 adrenia, supervening in the course of acute infectious diseases, several 

 observers have reported beneficial results from the hypodermic administra- 

 tion of epinephrin (15 minims of a 1:1000 solution). Sammartin has 

 recommended the oral administration of epinephrin, 5 minims or more, 

 every three hours, to keep the blood pressure normal in typhoid fever, re- 

 porting good results in six cases thus treated. The intratracheal admin- 

 istration of epinephrin, by means of a spray, has been advised by Wolff- 

 Eisner, in the treatment of influenza and influenzal pneumonia. Inasmuch 

 as the effects of epinephrin are transient, Sajous advises small repeated 

 doses (10 minims every two or four hours), given hypodermically, during 

 the stage of assumed suprarenal failure in the acute infections. The intra- 

 spinal administration of epinephrin (3 c.c.) has been suggested by Auer 

 and Meltzer(fr), these authors having observed a more prolonged eleva- 

 tion of the blood pressure following this method of administration. In 

 the so-called "nitroid crises" following the administration of arsphenamin, 

 as well as in the anaphylactic phenomena associated with bacterial inocula- 

 tions, some writers have found the administration of epinephrin of great 

 therapeutic value, attributing such phenomena to a sudden arrest of supra- 

 renal function. The prophylactic administration of epinephrin, some 

 hours before the making of an antityphoid inoculation, has been advised by 

 Satre, Loeper(a) and others. Some observers have, however, failed to con- 

 firm such beneficial results from the use of epinephrin in these conditions. 

 Cowie and Beaven found that it was of no aid in the treatment of influ- 



* In this connection it should be borne in mind that animals survive perfectly well 

 what appears to be complete suppression of epinephrin discharge from the supra- 

 renals. R. G. H. 



