THERAPY 227 



tioned above the conspicuous intercurrent improvement occurred after the use 

 of adrenal tablets. Whether an intravenous injection in man of suprarenal 

 extract, which has been advised, will produce a more intense action than other 

 methods, and whether it will not also produce dangerous symptoms, appears 

 to be questionable. 



That the results by means of adrenal treatment in Addison's disease are 

 no more definite and gratifying than those mentioned above is not surprising, 

 nor can they be looked upon as final. For, in the first place, the number of 

 investigations is much too small to determine this therapeutic question. I 

 estimate the number of cases that have been accurately reported as much less 

 than 100.; and in most of these it must be remembered that there was oppor- 

 tunity for suprarenal treatment only for a short time, or only very late in the 

 course of the disease, so that the condition was an unfavorable one for therapeu- 

 tic results. Therefore a long continuance of observations will be necessary 

 before a definite opinion can be given regarding the value of organotherapy in 

 Addison's disease, and to decide whether the apparent favorable results in 

 individual cases will be guaranteed by further observation. 



But even if organo-therapeutic results should not improve with increasing 

 experience, this circumstance cannot be used to nullify the importance of 

 the adrenal function in the pathogenesis of Addison's disease. The thera- 

 peutic introduction of adrenals from animals, or of extracts obtained from 

 these, can only substitute in a very feeble way for the secretion furnished by 

 the living gland in the human organism. Action similar to that which is 

 exerted directly by the adrenals upon the fluids of the body can hardly be 

 expected from the peripheral absorption (through stomach, skin, etc.) of the 

 finished products, especially since the latter, as all physiologico-chemical inves- 

 tigations have shown, are subject to great destruction in the tissues of the 

 body. Comparison with the remarkable action of the extract of thyreoid 

 gland which, even in the first investigations of substitution therapy was shown 

 to cure myxedema, should not lead us to expect similarly easy and surprising 

 results in all analogous investigations (even although they appear to be patho- 

 genetically well founded), since the physiologic and pathologic conditions in 

 many other organs are certainly much more complicated than in the case of 

 the thyreoid gland and its functions. 



As regards the influence of organotherapy in Addison's disease, we must 

 content ourselves for the present with stating that the experiences ivliicli have 

 been gathered are not sufficient to permit a conclusion. They are also insuffi- 

 cient to determine the likelihood of improvement or cure, or to decide theo- 

 retically whether or not the artificial introduction of adrenal secretion is a 

 proof of the adrenal theory in Addison's disease. But neither do the reports 

 at hand require that we should cease to hope that further and more exact 

 therapeutic investigations will furnish better results. 



From this, future observers may learn the practical lesson to test the 

 adrenal treatment of Addison's disease upon every opportunity. If we begin 

 the treatment in individual cases as early as possible, and compare the influ- 

 ence of the various modes of administration, we shall gradually be able to 

 determine what to expect from this method of treatment, and to recognize 



