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Treatment - Addisons Disease and Other

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TREATMENT - ADDISON'S DISEASE AND OTHER It has to be confessed that with increase iu our knowl edge both of the nature and symptoms of this malady no coiTespond ing improvement has been made in respect of its treatment.

Having regard to the lowered vitality and impaired health which form the special features of the disorder, efforts have always been made to raise the level of nutrition, and place the patient in the most favorable condition to attain the highest general health possible.

In addition to this, the various urgent symptoms have been met as they arose.

The main line of treatment indicated by a consideration of the primary pathological process in the adrenal bodies is that proper for tuberculosis in any part of the body. Hence, removal from urban environment to pure country air and wholesome dwelling-places is imperative. The patient is little capable of attending to his duties, whether domestic or of a business nature. Asthenia is the key-note of the malady. Generous diet, containing all nutritive elements in abundance. is desirable, and some good wine should be given. All varieties of fresh meat and fish, also oysters, with well-cooked vege table food, fat, cream and milk, and farinaceous food are allowable.

When gastric irritability is present, the diet must be altered, and treatment as for nervous vomiting be adopted. Recumbency is nec essary, not seldom, both for this symptom and for the cardiac debility which is commonly associated with it. Milk and lime-water, one part of the latter to two parts of the former, given in teaspoonful doses at in tervals of a quarter of an hour, by the clock, will often be borne by very irritable stomachs. Larger quantities may be rejected. Whey is useful, and kninyss may be available. No solid food is permissi ble. Valentin's beef-essence, given with iced water in small quanti ties, may be borne. Sometimes it is well to cease feeding altogether the mouth, and to resort to rectal alimentation by nutrient ene mata or suppositories. A day or two of complete rest to the stomach may thus be secured, and subsequently simple food may be naturally retained. Alcohol in some form is generally necessary, and brandy

with aerated water or champagne diluted with the latter or with iced water may be well borne, and some brandy may also be put into the nutrient enemata. Sinapisms to the epigastrium are useful for the vomiting, and various medicines are available for this troublesome symptom. Tartrate of sodium in effervescence with a few minims of dilute hydrocyanic acid is often serviceable, or a small pill containing one-fourth of a grain of morphine and a minim of creasote may be given. Hypodermic injections of a sixth of a grain of morphine with one-hundredth of a grain of atropine may be employed.

Recurrent paroxysms of gastric irritability and of cardiac asthenia form part of the history of many cases of Addison's disease, and as these pass off under rest and suitable treatment the patient may im prove materially in all respects for weeks or months. The cases vary in degree and in acuteness, as has been already noted.

It has been proposed to apply counter-irritation to the loins by means of liniment of iodine, with a view to treat the chronic inflam matory processes in the adrenals and the adjacent nervous plexuses, but not much benefit can be expected from such a course.

There is no special indication for treatment derivable from the theory that many of the morbid conditions are due to the circulation in the system of toxines, produced by the imperfect pigmentary metabolism which is necessitated by disease of the adrenals.

A new era in therapeutics has certainly dawned since the discov ery that the ravages of myxcedema may be checked and almost, if not quite, abolished by supplying to the system the material of the thyroid body which is cut off owing to the morbid condition of the gland in that malady, and it has been surmised that we may do good in Addi son's disease by grafting adrenal tissue into some part of the body, or by employing an extract from the adrenal bodies of the sheep in a manner similar to that practised in cases of nayxoedema.

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