132 THE DUCTLESS GLANDS 



to infection. Traumatic haemorrhage into the substance of 

 the gland has been stated to be the starting-point of the lesion 

 in some cases. 



The onset is nearly always insidious and gradual. Gastric 

 trouble is perhaps one of the commonest causes of the patient's 

 seeking advicev Very rarely the disease seems to come on 

 suddenly after a shock or some cause of worry. It may be 

 congenital. 



4. Metabolism in Addison's Disease 



Owing to the rarity of Addison's disease, little is known as 

 to the general (total) metabolism. Nor have we any a priori 

 grounds for assuming that this would be either increased or 

 diminished. 



According to a brief account given recently by Richter, 

 the protein metabolism is not appreciably affected. Senator 

 and Pickardt observed either nitrogenous equilibrium or, with 

 abundant food, nitrogenous gain. On administration of 

 adrenal substance to the patient there was no increase of 

 protein destruction. 



There is an increase in the phosphoric acid elimination. 

 Richter suggests that this has to do with increased destruction 

 of bone substance, though Senator found the calcium elimina- 

 tion not raised. 



Nothing certain is known of any change in carbohydrate 

 metabolism. We might expect, since adrenin pharmaco- 

 dynamically induces glycosuria, that in Addison's disease, 

 where there is presumably a deficiency of this substance, 

 we should find a lowering of the sugar content of the blood. 

 In experiments upon animals after extirpation of the adrenal 

 bodies, this is actually found to be the case, but the clinical 

 evidence in the case of the human subject is meagre and con- 

 flicting, although Bernstein and Falta believe that hypo- 

 glycaemia is a sign of some diagnostic value. 



There seems to be actually a diminution of the urinary 

 pigments. 



5. Morbid Anatomy 



In Addison's original paper eleven cases are recorded. In 

 five of these there was caseous tubercle in both adrenal glands, 

 and in one case tubercle was only present in one gland. One 





