By DWIGHT J. INGLE, Ph.D.

Connections between the function of the adrenal cortex and some of the great diseases have been suspected ever since the association between adrenal cortical tumors and the symptoms of Cushing's disease was noted. Some patients with Cushing's disease have hypertension and some have diabetes. More recently it has been observed that some patients with primary aldosteronism are hypertensive. All the reasons for postulating a relationship between adrenal cortical functions and disease were brought into focus by Selye's concept of the "adaptation diseases," in which the derailment of adrenal cortical function during exposure to nonspecific stress was assigned a key role in the etiology of many diseases.

The impact of this hypothesis was great. The hypothesis is lucid and the supporting evidence plausible. The hypothesis offers to medicine the greatest insight into the processes of disease and the greatest hope for the cure and prevention of disease of any that has come from the laboratory. It did, indeed, come from a series of brilliant experiments. The hypothesis has also been appreciated by critical students of pathogenesis who have recognized it as logical and heuristic but who have not been persuaded to accept it on faith or without further testing. The popularity of the hypothesis has faded somewhat, in part because it has not yet met any of the requirements for proof of a proposition, and in part because of the many other exciting ideas and discoveries in the medical sciences.

Some of the ideas which have been woven into the concept of the adaptation diseases are a part of the "conventional wisdom" of biology and medicine. I have borrowed this term from Professor John Kenneth Gal-braith of Harvard University.

By "conventional wisdom" is meant the body of ideas generally accepted and cherished. This includes ideas which are not yet scientific verities. Each population of scientists, as well as nonscientists, has a set of faiths the hallmark of which is acceptability. This is a means of moderate acclaim: say to your fellows that which they already believe or find acceptable. A set of challenges to conventional wisdom will not bring acclaim unless supported by logic and evidence of such force that a portion of this body of faith is destroyed and replaced by a more tenable and useful concept; this can establish fame-and if done outside the basic sciences, perhaps fortune. In medicine as in other sciences, an old idea may achieve new appeal when it is put into new form. The idea that longevity is limited by the stresses and strains of life is as old as history and is generally believed. It is a cornerstone of the Selye concept of disease, where it becomes more attractive when described in terms of the exhaustion of adaptation energy. A closely related idea is that resistance to disease is lowered during exposure to stress. There are some data which support the belief that resistance to certain infectious diseases is decreased by exposure to certain stressors,1 but even here further inquiry is in order. The idea that disease, especially the degenerative diseases, can be caused by stress has become a part of the conventional wisdom in medicine.

It would be difficult to define stress in a way that would exclude an active cause of a disease from being considered a stressor. It would be difficult to define disease as not representing failure of adaptive mechanisms. When Professor Selye speaks and writes in broad terms about disease resulting from failure of adaptive mechanisms during exposure to stressors, and especially when he reviews the many systems in the body that may be involved in disease, it is difficult to find a debatable idea. But Professor Selye has not been bound by the conventional wisdom of medicine. He has had the courage and creativity to venture beyond it with a force of thought and evidence that have commanded attention and stimulated inquiry. It is when Professor Selye2 emphasizes that primarily important in causing pathology is a change in the secretion and/or metabolism of adrenal steroids during exposure to stress, are we presented with a heuristic idea which we wish to study and debate.