THE ADRENAL BODIES 131 



and sometimes diarrhoea. But there may be constipation 

 from loss of muscular tone. 



Sometimes there is an alternation of constipation and diar- 

 rhoea, which latter frequently occurs without obvious cause. 

 Towards the end there may be pain with retraction of the 

 abdomen, and small pulse, the condition strongly suggesting 

 peritonitis. 



Various symptoms referable to the nervous system have 

 been described. Some of these, such as twitchings and con- 

 vulsions, point to irritation of the nervous system, but the most 

 characteristic, such as a diminished or absent knee-jerk, are 

 indications of depressed activity of the nervous system. Head- 

 aches and faintness are not uncommon. 



Insomnia, loss of memory, noises in the ears, vertigo, pains in 

 the trunk and limbs, and mental symptoms with hypochondria 

 are also mentioned. 



The "white line" of Sergent has been recommended as a 

 test for adrenal insufficiency. The method employed is to 

 outline a square about the umbilicus with a blunt object by 

 quite superficial stroking without using pressure or scratching. 

 The patient should be kept still, and after half a minute, a 

 pale line or band begins to appear which gradually becomes 

 more distinct and white. It attains its maximum clearness in 

 about one minute, persists for two or three minutes, and gradu- 

 ally disappears. The theoretical explanation given by Ser- 

 gent is not satisfactory. The normal response to light stroking 

 appears to be a brief vaso-dilation followed by a vaso-constric- 

 tion. The failure of this normal reaction is stated to be a sign 

 of adrenal deficiency. 



3. Etiology and Onset 



The disease is rare. It is doubtful whether one sex is affected 

 more than the other ; it occurs about the thirtieth year on the 

 average. The adrenal bodies may become infected in tuber- 

 cular patients from the mesenteric glands or from disease of 

 the vertebrae. But the adrenal bodies themselves seem to be 

 susceptible to primary tuberculosis, and are often the only seat 

 of tubercular infection in the body. 



Strains and injuries to the back or blows on the abdomen 

 have sometimes been alleged to be the cause of the mischief. 

 In these cases the trauma might render the gland more liable 



