Internal secretion and the ductless glands / by Swale Vincent.

  • Vincent, Swale, 1868-1934.
Date:
1924
Catalogue details

Licence: In copyright

Credit: Internal secretion and the ductless glands / by Swale Vincent. Source: Wellcome Collection.

    188/488 (page 168)
    A. Pure adrenal insufficienov. 1. Fulminating (with sudden death). 2. Acute syndrome Sergent-Bernard ”). 3. Sub-acute. 4. Mild petite insuffisance ”). B. Adrenal insufficiency with involvement of the peri- capsular nerve plexuses. 1. Addison’s disease. The fulminating cases are of medico-legal interest only as the patient is suddenly struck down dead. Upon a post¬ mortem examination the only lesion found is destruction of the adrenal bodies. Addison’s disease, when typically present, is a well-defined condition which may be recognized with some certainty. The other varieties mentioned give rise to very diverse clinical appearances, as will be seen from a consideration of the symptoms. The cardinal symptoms are arterial hypotension and asthenia of varying degrees. Digestive disturbances, such as vomiting, diarrhoea, constipation, or severe abdominal pain, giving rise to a diagnosis of some acute abdominal catastrophe, may be superadded. Excitement, convulsions, encephalopathy, ab¬ normal eye signs, or coma may be present. Syncope, small pulse, tachycardia and other symptoms suggestive of cir¬ culatory disorders may be found. The clinical picture being thus so ill-defined, certain recognition of these cases becomes almost impossible in the absence of some pathognomonic sign. This, Sergent contends, he has supplied in a skin reaction which he calls the '' white line ” {ligne blanche surrenate). If the skin of the abdomen in a suitable individual be lightly stroked with some round smooth object, it is found that after a definite latent period a white line appears which gradually increases in intensity and definiteness. It persists for a minute or longer and then slowly fades. This phenomenon was first noted quite accidentally in a patient in whom a diagnosis of meningeal irritation had been made. The involve¬ ment of the adrenals was not suspected at the time, and was revealed only by the post-mortem examination, which showed that the glands were almost completely destroyed by caseating tuberculous masses. On subsequent investigation Sergent claims to have found the white line constantly present in sub¬ jects showing symptoms of adrenal insufficiency. He also