sleep, recreational trips, vacations slip into the rank of necessities, whereas previously they had been laughed at as luxuries.  More minute or large moles emerge in the skin, especially if the individual is of a fair type.  If a strenuous effort is not made to give the adrenals an opportunity to recuperate, or if adjustment on the part of the other glands does not occur, this stage of intermittent and remittent adrenal inadequacy gives way in turn to the state of permanent adrenal insufficiency.

The adrenal insufficient is important because he is to be seen everywhere.  Built along the same lines as the adrenal adequate and apt to be taken for him, he differs and contrasts vividly below the surface.  One may sum him up by saying that he is one variety of neurasthenic, perhaps the most frequent variety.  Cold hands and feet plague him, cold feet psychically as well as physically, for a chronic and obsessive indecision is one of his most prominent complaints.  A fatigability, that goes with a low blood pressure, lowered body temperature and a disturbed ability to utilize sugar for fuel purposes, is another of his chief complaints.  The skin often presents an instability of the blood vessels, so that they now react to stroking with a blanched instead of a reddened effect.  Irritability, a liability to go off the handle at the slightest provocation, and a consequent complete exhaustion that, after an outburst, sends him to bed, is conspicuous.  Dismissed sometimes contemptuously as weaklings, they are accused of laziness, craziness, and haziness.  In their psychic attempts to compensate, they land into all kinds of hot water, from which friends, relatives or luck extricate them sometimes.  The other times they go to the wall.

The congenital adrenal deficient is a special problem.  If the history of such an individual is followed from birth, one gets a pretty typical story.  The genealogy is nervous.  Nervous is a word of many meanings.  But when parents confess themselves nervous, it generally means a mental and emotional instability of some sort.  Sometimes the idea is camouflaged as high strung.  In the feeding narrative of the child, one finds not occasional incidents or episodes, but continued trouble, difficulties, adventures.  Even after the first year or two, the nutritional chronicle is not satisfactory.  Lack of appetite, lack of energy, lack of response to stimuli are its keynotes and the motifs of the later years of childhood.

Growth is a strain.  It becomes a task to make these children grow and gain.  Chronically below the average weight and height, herculean efforts are made by the conscientious parents, but with small success.

With the entry of school life and competition, the curtain rises upon the real tragedy, a tragedy in which the avenging Fates are the usual ignorance, stupidity and misunderstanding.  If the teachers alone are duty-obsessed, or perhaps sadistic, the child endures the agonies of repeated admonitions, demotions, and punishments.  However, a certain thick-skinned indifference may develop to protect the sufferer.