THERAPY 225 



renal extirpation, life could he prolonged for twenty-four hours ly injections 

 of suprarenal extract (Andersson and Hultgren). Moreover, experience 

 proved that in disease of the thyreoid gland, which may be looked upon as an 

 analogous condition, by a simple substitution therapy, the deleterious conse- 

 quences of the absence of the thyreoid could be combated, and a fatal general 

 affection, such as myxedema, could thus be transformed into a harmless con- 

 dition. Therefore, it is not surprising that in the last eight or nine years, 

 following the English physicians, various investigators have attempted to 

 employ suprarenal therapy in Addison's disease, in which either the gland in 

 substance or preparations obtained from the glands were introduced into the 

 body. Besides the amelioration or cure of the affection, they hoped in this 

 manner to demonstrate, more conclusively than by the animal experiments, 

 the direct dependence of the disease upon the disappearance of the adrenals, 

 and also to show that the physiology and the pathology of the adrenals were 

 directly analogous to the thyreoid gland and athyreoidism. 



Unfortunately the results of suprarenal treatment in Addison's disease 

 have not justified these hopes. No cure of the disease in this way has been 

 recorded up to the present time. Yet a certain number of cases have been 

 reported in which by this treatment transitory improvement followed, and was 

 so conspicuous that it could not be disregarded entirely. Among these cases, 

 perhaps the most convincing are those in which, after cessation of the specific 

 treatment, an aggravation of the general condition occurred, and, eventually, 

 pigmentation of the skin followed; of these, two are particularly worthy of 

 mention : 



Thus Schilling (1897) reports the case of a boy, aged fifteen, who was 

 ill for two years 'and showed quite decided bronzing. For three months raw 

 adrenal substance was administered to him (a fresh gland from a sheep or 

 lamb daily). During this time an almost complete disappearance of the 

 abnormal pigmentation occurred (only a slight discoloration upon the mucous 

 membrane of the mouth remaining) and an increase in strength and of weight 

 (33 pounds) so that he was looked upon as almost well. After a three months' 

 cessation of the treatment, and following sudden symptoms of intoxication, 

 death occurred (perhaps in consequence of a beginning pneumonia). The 

 adrenals were contracted almost to cicatrices, and permeated by caseous foci. 

 More striking, perhaps, is the case observed by Edel (1900) : A locksmith, 

 aged thirty-three, in whom the symptoms of rapidly increasing weakness and 

 bronzing, particularly of the face, dorsum of the hands, and penis, had existed 

 for six months without showing any remission. Suprarenal tablets were 

 administered (one gram each, two given twice daily), and after only two to 

 three days his strength began to increase, so that after fourteen days he was 

 able to return to work; moreover, the bronzed areas of the skin began to 

 improve from the third day of treatment, and five weeks later hands, face 

 and penis, with the exception of isolated areas, were again of a normal color. 

 After a month and a half of improvement, tubercular meningitis set in and 

 caused death in seven days. From the beginning of this complication the 

 adrenal tablets had been stopped, the bronzing reappeared, and a short time 

 prior to death had almost completely returned. The autopsy showed, besides 

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