ADDISON'S DISEASE 



By L. REISS, Berlin 



In recent pathological discussions attempts have been made to refer the 

 clinical symptoms in a number of general affections to a so-called " auto- 

 intoxication " produced by the decrease or absence of the " internal secretion " 

 of an important organ of the body. Of course this view refers chiefly to those 

 forms of disease in v^hich clinical and pathologico-anatomical experience 

 have taught us to recognize the invariable predominance of changes in an 

 organ having a secretory character. An example which best illustrates this is 

 the wonderful symptom-picture of myxedema, the direct dependence of which 

 upon a cessation or absence of function of the thyreoid gland has been lately 

 proven with all the certainty that can be desired. 



To the general diseases, in which, at the first glance, it must be obvious 

 that similar functional disturbances are causative, belongs also the remarkable 

 symptom-group which, about the middle of the last century, was first accu- 

 rately described by the English physician, Addison, and to which, therefore, 

 his name has been attached. The relation of this clinical picture to a well- 

 defined disease of the adrenal bodies which is present in the majority of cases 

 has governed the views of observers from remote times regarding the nature 

 of the disease, and in spite of the many difEerences of opinion which have 

 become prominent in the last decades regarding the pathogenesis of Addison's 

 disease, the great majority of physicians maintain that a cessation of the 

 function of the adrenals is the essential basis of the affection. It is also in 

 harmony with this view that lately, by a transference of the practical question 

 of the treatment of this affection by organotherapy, favorable expectations 

 have been aroused so that many trials have already been made of this 

 method. 



But nevertheless, upon closer observation, the conditions do not appear so 

 simple. Many of the clinical symptoms cannot be referred without further 

 consideration to a disturbed function of the adrenals; a constant group of 

 clinical and anatomical findings cannot be said to have been found, and thus 

 an accurate weighing of the experiences gathered up to this time leads to the 

 conclusion that the exclusive dependence of Addison's disease upon disease 

 of the adrenals, although in many respects quite likely, has not been absolutely 

 proven, and does not suffice fully to explain the pathogenesis of the disease. 



Under these circumstances, it is instructive to investigate the most impor- 

 tant points and ascertain whether or not the weight of evidence points to 

 a direct dependence upon disease of the suprarenal bodies. In the following 



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