Effects of Suprarenal Removal : Epinephrectomy 57 



Experiments on adrenal transplantation have for the most part led to 

 negative results. The graft almost invariably undergoes rapid necrosis and 

 disappears, although Haberer and Stoerk obtained some success by im- 

 plantation into the dog's kidney. Administration of suprarenal extract 

 is unable, either in Addison's disease or in the cachexia produced by 

 extirpation, to prevent the usual fatal termination, although this may be 

 somewhat deferred. The muscular weakness characteristic of Addison's 

 disease may for a time tend to disappear with the administration, so that 

 the ergographic record may again approach the normal. But such ad- 

 ministration cannot, as in the case of cachexia thyreopriva, take the place of 

 the internal secretion of the gland, and until measures are found to induce 

 grafts to take in man, Addison's disease will probably continue to termi- 

 nate fatally. With the progress of surgery the possibility of successful 

 implantation seems less hopeless than was the case only a few years ago. 



After extirpation of one gland only there is a compensating hyper- 

 trophy of the other, and also of the accessory bodies. Castrated animals 

 were found by Hultgren and Andersson to live much longer after the com- 

 plete operation than normal individuals. This is also stated to be the case 

 if the complete operation is performed in two stages, first the capsule of the 

 one side and then that of the other being removed. The result is perhaps 

 due to the fact that time is thus given for a process of hypertrophy of 

 accessory bodies. With regard to the total amount of suprarenal substance 

 that must remain in order to maintain life, Biedl found in cats, dogs, and 

 rabbits, that if one-eighth of the whole suprarenal substance is left the 

 animals always survive. He further found that if the interrenal body 

 alone is removed in the skate the animal dies in two or three weeks, 

 becoming progressively weaker and refusing food. In one skate in which a 

 small portion was left, these symptoms were absent. He concludes, after 

 a survey of all the experimental evidence on the subject, that it is 

 abundantly proved that the suprarenals are not only important but are 

 essential to life, and that it is probable that this is due to some material 

 yielded by the cortex although the loss of the adrenalin which is supplied 

 by the medulla may be contributory. 



It appears that in other diseases than Addison's the functions of the 

 suprarenal capsules to a great extent become suppressed. In diphtheria 

 and after injection of diphtheria-toxin in animals, it has been found that 

 the amount of adrenalin yielded by the medulla of the suprarenals is much 

 diminished, and may even in extreme cases disappear altogether. In 

 cholera also the amount is greatly diminished ; it is stated that in this 

 disease subcutaneous administration of adrenalin is markedly beneficial. 

 If this diminution in the amount of adrenalin formed should prove to 

 hold good in other acute infectious disorders, it would seem probable that 

 interference with the functions of the suprarenal capsules is in large 

 measure responsible for the cardiac weakness and general loss of tone 

 which are prominent symptoms in such affections. 



