Volume 1

Green's Encyclopedia and dictionary of medicine and surgery / edited by J. W. Ballantyne.

Date:
1906-1909
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Green's Encyclopedia and dictionary of medicine and surgery / edited by J. W. Ballantyne. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    83/576 (page 65)
    Suprarenal extract is advocated as a cardiac tonic and stimulant in the treatment of ?teart disease (Bates, Floersheim) and of pneumonia (Gray); and as an intravenous injection it is recommended by Scliafer in cases of sudden cardiac failure, the residt of shock, liajmorrhage, or overdose of an anaesthetic. The extract has been employed with benefit in some, though not in all cases of Addison's disease, in rickets (Stoeltzner), and chiefly as a local application in acne rosacea (Munro); and, lastly, Peters records cases in which it was serviceable in allaying the pain of cancer and of chronic inflammation. [An important use of adrenalin is in com- bination with cocain or eucain for the production of local aniBsthesia. Alone, adrenalin does not cause anaesthesia, but in combination with either of the above - named drugs it increases their anasthetic effect and prolongs the resulting anasthesia. It would seem also to diminish the toxic effects of the cocain. Eight to ten minutes should elapse after the injection is made before the operation is begun.] Addison's Disease Definition ..... 65 History ...... 65 Frequency' : Age . 65 Etiology ...... 65 Morbid Anatomy 66 Pathology ..... 67 Theories as to Nature op the Disease 68 1. 7Vtp Nervous Theory . 68 2. Adrenal Inadequaci/ . 68 3. Theory of the Duality 68 Onset and Course .... 68 Sympt'oms ..... 69 Duration ..... 70 Diagnosis ..... 70 Prognosis ..... 71 Treatment ..... 71 1. General ..... 71 2. By Adrenal Substance 71 Definition.—A constitutional disease, charac- terised by an exaggeration of the normal pig- mentation of the skin, extreme asthenia, and a tendency to syncope, nausea, and vomiting. During life no morbid lesion is discoverable, and after death alteration of the adrenal bodies is the chief or only change found. History.— This disease was discovered by Dr. Thomas Addison, Physician to Guy's Hos- pital, while hunting for the cause imderlying pernicious ana'mia. His conclusions were first actually published as far back as 1849 in a com- munication to the now extinct South London Medical Society, and reported in the London M'edical Gazette of that year ; but it was not till five years later that his illustrated monograph on the constitutional and local effects of disease of the suprarenal capsules saw the VOL. I light. But even then the recognition of this discovery was tardy, and it is possible that but for Sir Samuel Wilks' loyal energy the obser- vations might have passed comparatively un- noticed in this country. In France, Brown- Sequard had at once been stimulated )iy Addison's discovery to investigate the physiology of the adrenal bodies. Trousseau, after a considerable interval, called the disease by Addison's name. The late Dr. Headlam (Jreenhow collected a large amoiuit of valuable material in his Croonian lectures before the Royal College of Physicians in 1875. But from this time until after the discovery that myxoedema could be satisfactorily treated by thyroid extract, and the resulting physiological researches into the internal secre- tions of ductless glands, no special attention was paid to Addison's disease. In the last five years a good deal of interest has been manifested both in the pathogeny and in the treatment by adrenal extract of Addison's disease. Frequency. Sex.—Addison's disease, though now thoroughly well known and recognised, is decidedly rare ; it occurs more often in the male sex. In 183 cases regarded by Greenhow as unequivocal examples of the disease, 119 (or 65 per cent) were males, and 64 (or 34 per cent) were females; and in 49 cases recorded as occurring luider sixteen years, 30 (or 61 per cent) were males, and 19 (or 39 jjer cent) were females. In Jaccoud's series of cases the pro- portion was much the same. Age.—The average age at death is about thirty-one years ; but instances at the extremes of life have been pul)lished, from seven days after birth, to eighty-one years of age. It is rare below puberty, but Dezirot has collected 48 cases under sixteen years of age. In connec- tion with the observed fact that Addison's disease is rare in early life, it is of interest to note that in cases of tuberculosis of the other organs of the body, the adrenal glands appear to be remarkably immtnie to secondary infection in the early years of life. Etiology. — Greenhow lielieved that the disease was disposed to by hard physical exer- cise, and by traumatism and local injiu'ies to the back, and he connected with this theory the rarity of tlie disease among the well-to-do classes. It should, however, be borne in mind that not only are the well-to-do less nmiierous, but inas- much as they are better fed they are less susceptible to tubercidosis, which is found to be the nature of the suprarenal lesion in about 80 per cent of the cases. Very little is known as to its geographical distribution; Osier regards it as less rare in Europe than in America; very few cases have l>een described in the dark-skinned races of tropical countries, but this is ])robably due to the difficulty of recognising the disease clinically in the blacks. It would natiu'ally be expected that the 5