Addison's Disease.— This is a more chronic type due to more or less total involvement. As early as 1855 this disorder was first described by Thomas Addison whose outline practically covered the essential symptomatology. It is a disorder of adult life, 30 to 40 years. Its chief features are a gradually developing asthenia, with arterial hypotension. There is morning nausea or vomiting, lumbar pains, an advancing yellowish pigmentation of the skin and mucous membranes, arnyatroply.. depres sion, unwillingness to do anything, with episodic occurrence of myoclonic, tetanotd or epilepti form convulsions with periodic palsies, con fusional states, delirium, chronic paranoid ideas, coma, death. The chief -lesion found is tuberculosis of the medulla of the suprarenal glands. The more complete symptom picture may be consulted in works on general medicine.
Partial Hypoadrenalemias.— These have been termed the abortive or latent types of Addison's disease. The melanoderma is ab sent, but the other symptoms noted are ob served. Constitutional hypoadrenalemic states no doubt are very numerous and show them selves as rare and obscure forms of lowered vascular tonus, cardiac instability, muscular asthenia, visceral and ligamentous ptoses. These are often correlated with a chronic sclerosing adrenal.
Hyperadrenalemia.— Several types are known, the most striking of which are: (a) Genito-adrenal syndrome of pseudoherma phroditism, (b) virilism, (c) precocious macro genitosomia. The fact that these syndromes occur only in women, as well as the pathologi cal data, point to a simultaneously invoked ovarian disturbance. These are feminine hermaphroditic forms externally with virile secondary male sexual characters. The earli
est case reported was by Crcechio in 1865, of a woman of 52, taken to be a 'man. She had a large penis-like clitoris with hypospadias, no scrotum nor testicles, a uterus with two tubes, two ovaries without trace of corpora lutei, and an enlarged and voluminous suprare nal. She had been markedly asthenic, dying in a syncopal attack with vomiting and persistent diarrhoea. Other cases show other combina tions such as amenorrhoea, gynecomastia, adi posity, hypertrophied clitoris, hypertrichosis, masculine voice, muscular activity, nervous and agitated, even overactive. Others only show continued hypertension and secondary arteri osclerosis possibly with glycosuria. Some patients pass through a nervous agitated crisis with all signs of marked hypertension, ap proaching a manic episode.
The virile type are made up of those in tensely masculine females with traces of beards and often with marked homosexual traits.
The third type consists of the °infant her cules" anomalies, who at the ages of from four to eleven years develop genital hair, beards, general hypertrichosis and markedly older skeletons. Sometimes the intelligence is precocious, again they are imbeciles.
Therapy.— Polyglandular opotherapy with careful analysis of each type may give relief in certain cases. The indications are slowly crys tallizing but cannot be even summarized here. Consult Jelliffe and White, 'Diseases of the Nervous System' (1917); Sergent, 'Les Glandes Surrenales' (1917); Pende, 'Pato logia dell apparato surrenale' (1909); Falta, 'The Ductless Glands' (1915) ; Gley, 'The Internal Secretions' (1917).