ISSO, he was able to pass half an out of bed. At the same time the pig mentation grew less marked and grad ually disappeared. At the end of two years the patient could be regarded as cured, and recovery has since been main tained. H. Neumann (Deutsche med.
Woch., Feb. 1, '94).
As the disease, in a large majority of the cases, has been shown to be tuber culous, there is no reason why some cases may not recover, as well as in some cases of tuberculosis of the lungs or other structures. A very guarded prognosis, however, is most judicious in all cases of this disease.
Treatment.—The tendency of medical investigators, in the last two or three decades, has been to seek for some one specific cause for each disease and for each a specific remedy. This has caused the careful consideration of the influence of predisposing causes to be more neg lected; less attention to be given to the influence of co-operative causes, espe cially in the production and maintenance of chronic diseases; and less appreciation of the effects of retained excretory prod ucts during the progress of diseases, both acute and chronic, and of consequent changes in therapeutic indications in dif ferent stages of progress. In accordance with these tendencies most recent writers have devoted but few words to the con sideration of the treatment of Addison's disease. Not being able to identify the specific or essential cause, we are assured that no specific remedy has been found, and that the treatment must be hygienic and palliative: i.e., we must endeavor to improve nutrition by suitable diet, and to mitigate the more important symptoms as they arise. The truth is, however, that very few chronic diseases arise from, or are perpetuated by, a single specific cause. Contrarily, most of them are readily traceable to the co-operation of several causes, some of which are called predisposing and others exciting factors. And even in the few chronic dis eases that have been traced etiologically to a specific exciting cause or pathogenic germ, as tuberculosis of the lungs, it is Z7.•
generally admitted that the specific germ alone rarely proves efficient in developing the disease without the aid of such pre disposing factors or conditions as had diminished the natural vital resistance of the system or of the organ attacked.
In the treatment of all such cases, therefore, it is very important that we investigate carefully the history of each patient that we may appreciate whatever predisposing influences had been opera tive, and execute such measures as will prevent their further influence. In the early stage of Addison's disease the pa tient should be relieved as much as pos sible from both hard physical labor and mental anxiety, and given free access to pure air of genial temperature and a fair variety of digestible food.
As the autopsies reported have shown the presence of tubercular degeneration, not only in the suprarenal capsule, but also in other structures in a majority of the cases, patients should be encouraged to go early to mild and dry climates at moderate elevations, and to take persist ently such remedies as have been most beneficial in the more common forms of tuberculosis. Of these, perhaps, for pro tracted use none are better than creasote, in some form, and nuclein, as they are both antiseptic and tonic to the digestive and assimilative organs. If the creasote is given in capsules, grain of strych nine, added to each dose, will aid in sus taining the functions of the cardiac and vasomotor nervous systems. Arsenic has been strongly recommended in such cases as will tolerate it in large doses without disturbing the stomach and intestines. In one case under my care the patient appeared to derive much benefit from potassio-tartrate of iron, given in mod erate doses in connection with digitalis. In the later stage of the disease, when the asthenia is profound, the patient should be kept much in the recumbent position, and his gastric and intestinal disturbances combated by the use of bis muth subnitrate, cerium oxalate, and sometimes creasote with codeine.