ADRENALECTOMY 145 



Grollman 198 found the survival period to be markedly pro- 

 longed by the use of spinal anesthesia instead of the usual 

 anesthetization with ether. In rats survival is markedly 

 prolonged by the use of intraperitoneally injected barbiturates 

 as compared with the use of ether. 



One may obtain a measure of the effect of the operative 

 interference (including the action of the anesthetic) in reducing 

 the survival period of an animal in the following manner: By 

 efficacious therapeutic treatment the animal may be restored 

 to normal and allowed to recover from the operative wound and 

 resume its normal growth and activity. If treatment of such 

 an animal now be suddenly stopped, it will be found that sur- 

 vival extends for a longer period than would have been observed 

 had the animal not been treated. We may consider the 

 difference between the observed survival period after cessation 

 of therapy of a series of treated animals and a similar series 

 allowed to die untreated as representing the period of life 

 shortened by the operation. 



The advantage of performing adrenalectomy in two stages 

 in order to prolong life beyond the period observed in a one- 

 stage operation, was first indicated by Langlois 380 in 1893 and 

 has been confirmed repeatedly by numerous workers. The 

 explanation for this phenomenon is quite obvious from our 

 preceding discussions. The extirpation of the more difficultly 

 removable gland in a preliminary operation and the allowance 

 of a sufficient time (a week or more) for recovery of the animal 

 permits the extirpation of the remaining gland with a minimum 

 of trauma and anesthesia. Dogs which survive adrenalectomy 

 for an average of only 3 or 4 days by the one-stage operation 

 will survive twice as long when the operation is performed in 

 two stages with an interval of a week or more between opera- 

 tions. 



Completeness of the extirpation. The completeness of the 

 extirpation is obviously important in determining the period 

 of survival. Fragments of the main gland or the microscopic 



