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The Adrenals and the Muscular Work. Langlois was the first to show that the adrenals are an important factor in the destruction of muscle poisons; and Dieulafoy noted the connection between asthenia and certain pathological adrenal states. The fact that one of the prominent symptoms of Addison's disease is severe muscular asthenia, has led many to believe that muscular efficiency is dependent upon the adrenal secretion. Other experimental proof has been brought forward to establish the association of these factors. Experimentally it has been shown that partial or complete ablation of the suprarenal capsules reduces the muscular power, and injections of extracts of these glands have a stimulating effect. " Cannon and Nice^ have attempted to unravel the relations of the adrenals to the muscular functions. There can be no question, from the evidence now available, that there is a marked improvement in muscular contraction after adrenal secretion is evoked or after epinephrin* is injected. A large part of this increased efficiency is unquestionably due to the improved circulation . . . and fatigued muscles may thus be prepared by the secretion of the adrenal glands for better response to the demands of powerful nervous discharges. The General Indications of Adrenal Therapy. The value of preparations of these glands is well known, and they are in general use to-day. Many thousands of articles and clinical reports concerning their uses are scattered throughout the world's medical literature. These are, for the most part, devoted to their styptic or pressor value. Adrenal preparations have a wider range of usefulness than is ordinarily supposed. The conditions in which this form of medication is of value may be divided into two classes: (1) Adrenal in- sufficiency or hypoadrenia, in which there is a definite pathologic lack of the chromaffin hormone, the chief among which are Addison's disease, adrenal tumours with consequent disturbed secretory function, certain acute infectious diseases, during which a hj^poadrenia develops [e.g., diphtheria, cholera, scarlet fever, typhoid fever), and certain nutritional disorders, especially osteomalacia, rickets, etc. (2) Those conditios in which the vaso-constrictive, myotonic or diuretic properties of adrenahne are available its empiric apphcation as a remedy.Addison's disease was naturally first among the disorders in which this form of treatment was tried, and while the results have been by no means uniform, numerous cases are recorded by such men as Oliver, Langlois, Osier, Robin, and others, in which the general condition was improved, pigmentation was diminished, and nutrition was benefited. In most cases the results were temporary, though Beclere^2 obtained a complete and permanent cure

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This is strictly the case, although the author is frank to state that the classitication as " empiric " of the application of the vaso- contractor action of adrenaline has been criticized. As a matter of fact, the word "empiric" comes from the Greek e/x7retpi/c6s, experimental, and is used to classify those methods of treatment that are based on experience. With this definition in in mind, the author's position will be clear. There is no particular lack of the adrenal hormone in, say, conjunctivitis ; but the application of what wc have learned from experience, as regards the local vaso-constrictor action of this substance, indicates that it would likety be useful in reducing the local congestion in the conjunctiva ; and clinical results have established the indubitable value of this empiric application. in one case. He credits the treatment with causing a compensatory hypertrophy of the unaffected areas of adrenal tissue. The dosage in Addison's disease is necessarily greater than ordinarily would be the case. Two or three grains of desiccated adrenal substance should be given three times a day. Hypoadrenia or Hypoepinephrinia. The disorders of the adrenals accompanied by anatomic changes are fortunately not very common, while functional hypoadrenia (sometimes termed " hypoepinephrinia "), varying very greatly in degree and the consequent manifestations, is of frequent occurrence. In general, the evidences of the presence of such conditions are lack of vascular tone, hypotension, myasthenia, and instabihty of the sympathetic nervous system. This class of disorders is still frequently overlooked; and, because of the intimate relations of the endocrinous organs, almost invariably associated with, and comphcated by, disturbances in other internal secretory organs.