224 ADDISON'S DISEASE 



ing course. In these remissions a cessation of all the clinical sjnnptoms not 

 infrequently precedes the fatal terminal stage, but the improvement cannot be 

 looke'd upon as the effect of treatment. However, it is quite likely that such 

 spontaneous remissions may be favored and increased by active symptomatic 

 treatment and general hygiene. 



That up to the present time no cure of a case of Addison's disease has 

 been authenticated has already been remarked. The fevi^ cases which have 

 been assumed to be such by their observers are doubtful as regards the diag- 

 nosis. Under these circumstances, the opinion of Potain, who is said to have 

 seen a case cured and who believes that the disease in one-tenth of the cases 

 is curable, is incomprehensible. Similar doubts are expressed in regard to 

 a case recently reported (by Oestreich), which is looked upon as an " operative 

 cure" of Addison's disease, and which I shall briefly mention: In a woman 

 whose pulmonary apex showed the symptoms of an old focus of infiltration, 

 and who suffered from marked cachexia, there was difficulty in digestion, gas- 

 tric and lumbar pains, and a tumor the size of a small apple was found in the 

 gastric region. This was removed, and after a good recovery from the opera- 

 tion the symptoms of the patient disappeared, strength increased, and in the 

 following nine months she was looked upon as well. The tumor was found 

 to be a tuberculous, degenerative adrenal organ surrounded by a fibrinous cov- 

 ering; the medullary substance of the organ was almost entirely destroyed. 

 That in this case extirpation of the tuberculous adrenal led to recovery cannot 

 be doubted; but unilateral, adrenal tuberculosis with cachexia and gastric 

 disturbance is not Addison's disease; and that the patient without an opera- 

 tion would have succumbed to Addison's disease is open to doubt. 



Thus, until recently, the symptomatic treatment of the clinical symptoms 

 has been the only therapeutic indication in Addison's disease, and besides 

 observation of the gastric and intestinal sjmiptoms (in which we were warned 

 quite properly against the use of extremely active or drastic remedies, as by 

 this means uncontrollable diarrhea may be produced), on account of the promi- 

 nence of the asthenic phenomena, the use of tonics was the main indication. 

 Iron and arsenic here played an important role, and I must mention that in 

 the two cases observed by me the longest quiescence of the disease with transi- 

 tory improvement of all the symptoms, also of the discoloration of the skin, 

 occurred after the continued use of Fowler's solution in large doses. 



An advance occurred in the treatment of the affection when the study of 

 the internal secretion of certain organs, above all of the so-called blood-vessel 

 glands, was combined with an attempt to introduce organotherapy. In fact, 

 a malady such as Addison's disease, in which evidently in the majority of 

 cases the main and occasionally the only known pathological basis consists in 

 the destruction and gradual functional deterioration of a blood-vessel gland 

 necessary to life, appeared to be particularly suitable for the modern therapy of 

 compensation. Theoretic and experimental investigations, above all the trials 

 with injections of suprarenal extract in animals, already mentioned and 

 described, show the conspicuous and important actions of this secretion. I 

 shall only add that in these animal researches the value of adrenal therapy 

 was in part directly confirmed : thus in experimental animals, after bilateral 



