THE SUPRARENAL SYSTEM 



1923 



and feet, and at times other parts of the body, and increased ex- 

 citabiHty of the nervous system. 



During the attack calcium salts should be administered. 



The curative treatment is to combat the intestinal toxaemia by 

 calomel and intestinal antiseptics, followed by thyroid therapy 

 as indicated above. Rickets must also be treated. The diet should 

 consist of milk, and meat should be avoided. 



THE SUPRARENAL SYSTEM. 



In 1563 Bartholomeus Eustachius Sanctoseverinatus recognized 

 the suprarenal capsules as distinct organs, but it was not until 1855 

 that Addison's researches aroused deep interest in these glands. 



No case has been as yet recorded of the absence of these capsules 

 as well as of the possible accessory suprarenals in man. Acute 

 suprarenal suppression is caused at times in man by haemorrhage, and 

 we quote such a case below. The syndrome of these cases is fever, 

 nervous symptoms, and signs of peritonitis^ followed by death. 

 Malaria may cause these signs. 



Chronic suprarenal suppression may be caused by malaria, and 

 is characterized by the signs of Addison's disease — viz., apathy, 

 adynamia, gastro-intestinal and nervous disturbance, associated 

 with bronzing of the skin and mucous membranes, and a chronic 

 cachexia, with frequently attacks of diarrhoea or convulsions, and 

 ending in coma and death. 



In the tropics we have met with Addison's disease once in a Euro- 

 pean, and with haemorrhage into both the suprarenal capsules twice 

 — once in a still-birth after a breech presentation in a native child, 

 and once in a case of acute suprarenal haemorrhage in a European 

 lady. This last showed symptoms so remarkable in character 

 that a brief description may be given. 



Acute Suprarenal Haemorrhage. 



After a year's residence in Ceylon, a young English lady, four months 

 pregnant, was suddenly taken ill with fever associated with an abnormally 

 quick pulse, great tenderness above the umbilicus, and pain in the small 

 of the back on both sides. After a short intermission the fever returned, 

 and rose to 104° F., with a pulse of 130, and quick respirations; the abdomen 

 became much distended and very tender, and the bowels were constipated. 

 All the organs were normal, as was the urine. Vomiting did not begin till 

 near the end, when the tongue first became coated and then dry. Hiccough 

 intervened before death on the tliirteenth day. Treatment was without 

 success in any way, and an exploratory laparotomy revealed no abnormality 

 beyond bowels distended with gas. On post-mortem examination, no 

 pathological phenomena were seen, except haemorrhages into both suprarenal 

 capsules, and, judging by the histology, this may have been a case of localized 

 malarial infection without any sign in the blood. 



THE THYMUS SYSTEM. 



The normal weight of the thymus at birth is 13*26 grammes, 

 and it should increase till between eleven to fifteen years of age it 



