228 ADDISON'S DISEASE 



whether there is any well founded hope of successful substitution therapy in 

 Addison's disease. As in the pursuit of pathologico-anatomical knowledge 

 of the disease, so here a long time may elapse, as cases of the disease which 

 are especially suitable for favorable treatment are very rare in almost all 

 countries. 



Thus we see that in the realm of practical therapy in Addison's disease 

 much is still obscure and much must be left for further investigation. 



If we now return to the question at the beginning of this article, whether 

 according to present knowledge we may declare that Addison's disease may he 

 explained hy an absence of the adrenal function, we must give the answer 

 already indicated more than once, that for several reasons this is impossible. 

 The numerous experiments which have been carried out in clinical, anatomical, 

 physiological, chemical and therapeutic realms in the last half century to 

 determine the basis of the disease have given us much knowledge regarding the 

 clinical picture as well as in regard to many properties of the adrenals. But, 

 as we have seen, important links are absent for the explanation of Addison's 

 disease as an affection of the adrenals alone. Hence, in disease of the gland 

 in combination with that of other organs, particularly of parts of the nervous 

 system, it now appears impossible to find this explanation without separating 

 the roles of these parts in the development of the definite clinical symptoms. 

 This conception will not appear strange to those who have endeavored to 

 explain the disease as a physiologico-chemical consequence of adrenal disease; 

 and I believe it to be more satisfactory than the subjugation of the pathologic 

 process to a restricted theory which, at least for the present, leaves several 

 phases unexplained. Whether this view will be accepted in the future, or 

 whether the adrenal theory in a purer form will be found sufficient for the 

 explanation of. the disease, will depend upon the results of future experience 

 and investigation. That these researches, together with our therapeutic en- 

 deavors, will in my opinion aid in the further explanation of the disease upon 

 a pathologico-anatomical and also upon a chemical basis has already been 

 indicated. Thus continued investigations in the interesting clinical picture 

 of Addison's disease, and the elaboration of the previous observations, are 

 bequeathed to the next decades of the new century as an object worthy of their 

 labors. 



