210 THE DUCTLESS GLANDS 



very unwise to administer simply the pressor substance ex- 

 tracted from the medulla. In the present state of our know- 

 ledge it would be far more desirable to give either the fresh 

 whole gland or extracts prepared from the whole gland, both 

 cortex and medulla. The pigmentation in Addison's disease 

 has probably never been experimentally induced, and certainly 

 has never been satisfactorily explained, and we are in the dark 

 as to whether this, one of the most striking symptoms of the 

 disease, is due to a lesion of cortex or of medulla, or is due to 

 damage to both. 



We have seen that the results of treatment of Addison's 

 disease by means of adrenal gland substance are as compared 

 with the effects of thyroid treatment in myxoedema distinctly 

 disappointing, though it may be that in some instances good 

 results have been obtained. Dr. Byrom Bramwell, who regards 

 the symptoms of Addison's disease as partly due to glandular 

 inadequacy, and partly the result of irritation of the sympa- 

 thetic in the neighbourhood of the adrenal bodies, explains the 

 failure of the extract in some cases by supposing that in these 

 instances there are adhesions to the sympathetic plexus and 

 irritation of it ; while the cases which react satisfactorily to 

 the extract are those in which there is only glandular inactivity 

 or inadequacy. 



Rolleston says : "It should be remembered that the medulla 

 alone contains the active physiological principle, the cortex 

 appearing to be inert, and that the extract is at present largely 

 made from the whole gland, and not, as would be physiologically 

 more correct, from the medulla alone. This must lead to a 

 certain amount of uncertainty as to the amount of active 

 principle contained in any pill or tabloid." It will be gathered 

 from what has been said above (p. 152) that it appears to the 

 present writer that it is far from certain that it would be 

 * ' physiologically more correct ' ' to give extracts made from 

 medulla only, or to give, as would probably be suggested at 

 the present time, pure adrenin. It seems safer, in view of our 

 ignorance of the precise pathology of the disease, to give an 

 extract made from the whole gland, or, better still, if adminis- 

 tration by the mouth be considered advisable, the fresh minced 

 gland. Because the medulla is the only part which yields a 

 powerful active substance to extracts, we must not assume that 

 n is the only part concerned in Addison's disease, 



