Definition

I can give no better definition than that given by Osler:

A constitutional affection characterized by asthenia, muscular and vascular, irritability of the stomach, and pigmentation of the skin--symptoms due, in all probability, to loss of the internal secretion of the adrenal glands. Tuberculosis of the adrenals is the common anatomical change.

Etiology

Males are more inclined to take this disease than females. The skin is of a yellowish-gray tint. The disease is thought to originate in an injury to the abdomen or to the spine--poverty of the adrenal enzymes.

Symptoms

Anemia, general languor, pronounced enervation and very enfeebled heart action, irritability of the stomach, and the peculiar change in the color of the skin. The first symptoms are those of weakness, weariness, and the peculiar coloring of the skin.

Change In The Appearance Of The Skin

This is usually the first thing to attract the attention of the patient or his friends. The coloration ranges from a slight yellowish to a deep brown or even black, The color is deeper on the exposed parts of the body. The areolae of the nipples and genitals take on a very much deeper hue. The stomach symptoms are those of nausea and vomiting. As the disease advances, there is pain in the abdomen. Toward the last there is complete loss of appetite. Diarrhea frequently develops--due, of course, to lack of digestive power; for, as the disease advances, the digestive secretions become less capable of preparing the food for absorption.

The general constitutional derangement is marked by a gradual decline in nutrition. The disease usually ends by fainting. This, of course, is brought on by the continued prostration, and becomes more and more profound. In some cases there are tuberculous lesions. Osler describes two cases as having ended in a delirium, with difficult breathing.

Treatment

Never having had a case, I cannot say very much about what can be done for the disease. It is always safe, however, to feed properly and give the foods that will give vitality and carry life into the system. Fresh fruits, raw vegetables, milk, and eggs, I should say, ought to be about the limit; and then, if the patient shows improvement, other foods may be given as indicated. Those who believe in animal therapy declare that the suprarenal injections have been used beneficially. Those who believe in drugs declare some benefit may be derived from arsenic, strychnin, and other drugs.