210 ADDISON'S DISEASE 



esses. Of the mimerous investigations of this character which have recently 

 been conducted three must be particularly mentioned : One of these bodies 

 has become known as " sphygmogenin " (Frankel) and is a syrupy substance 

 which shows marked reducing property, is easily oxidized, and with a watery 

 iron ehlorid solution gives a dark green reaction. Another substance named 

 " epinephrin " has been obtained by Abel from a watery extract of the adre- 

 nals as a benzoyl combination. As a result of elementary analysis Abel looks 

 upon it as an alkaloid belonging to the pyrrhol or skatol group, and obtains 

 from it by treatment with dilute alkali a dark pigment. Finally, v. Piirth, 

 after prolonged study, believes he has found a still purer body which he calls 

 " suprarenin," and designates as a dioxypyridin having a composition of 

 CgH^JSrOj or CjHglSrOa. This substance also raises blood-pressure upon sub- 

 cutaneous injection. How far the previously mentioned bodies actually repre- 

 sent the important secretions furnished by the adrenals to the blood must 

 be decided by further physiologico-chemical investigations. 



After this brief description of the results which have been obtained from 

 experiments and chemical investigation in regard to the physiologic action of 

 the adrenals, we return to the question: Can the clinical picture of typical 

 Addison's disease be explained from the lesion, that is, from the destruction 

 of these organs? 



Up to a certain point an affirmative answer may at once be given. We 

 can reconcile many important symptoms of the disease with a gradual decrease 

 and final cessation of function which, from the experience we have gathered, 

 may be ascribed to the adrenals, and we can find abundant analogies between 

 the condition of the person attacked by Addison's disease and the experimental 

 animal that has been deprived of its adrenals. 



First of all we recognize in the steadily progressive constitutional disease 

 which leads to death the same consequences of the loss of vital organs which 

 we found in the' experiments. That the duration and course here correspond 

 but little with those in the animal experiments is not surprising. Earely 

 does experimental disease in the animal accurately simulate the human dis- 

 ease, and still less so when, as in this case, the sudden removal of the organs 

 from the animal (even should the extirpation in part be undertaken at two 

 different times) is contrasted with a chronic disease in the human being with 

 very gradual loss of function. The duration of the disease in the human 

 subject is often many years — indeed disturbances of the adrenals are some- 

 times of such long standing that in the last periods of life a complete loss of 

 function of the organ must be assumed. Nevertheless we can sometimes find 

 analogy for this in the circumstance that for many months, even for years, 

 it is possible to keep the experimental animal alive. The nature of the general 

 disease in both cases is similar : In both, emaciation is present, but is not the 

 predominant symptom; in both the signs of true anemia are usually of mod- 

 erate degree. Against this the general asthenia, the permanent and increas- 

 ing weakness of most muscle groups, becomes particularly prominent in the 

 clinical picture, and reminds us strongly of the prostration which appears 

 so constantly in the experimental animal. 



