SURGICAL SHOCK 273 



the adrenals and shock. It was assumed that the abnormal 

 stimulation which leads to shock, depletes the adrenal stores 

 of epinephrine and thus leads to the observed drop in blood 

 pressure. We have seen, however, that normally epinephrine 

 plays no part in maintaining the vascular tone and that animals 

 deprived of their entire medullarly substance maintain a 

 normal blood pressure. We can thus dismiss the adrenal 

 medulla and epinephrine as involved in the causation of shock. 

 If shock really resulted from a depletion of the epinephrine of 

 the adrenals, one would expect a marked rise in blood pressure 

 to precede the fall. Such a rise is, however, not observed. 

 Stimulation of the splanchnic nerves, 178 exposure of the vis- 

 cera, 307 and sensory stimulation 105546 may cause an increase in 

 output of epinephrine but it is doubtful if this secretion has 

 anything to do with the ultimate development of shock in 

 these conditions. The depletion of epinephrine from the 

 adrenals in fatal cases of operative shock has been reported 

 by Bainbridge and Parkinson 27 and Elliott, 181 but other workers 

 have not confirmed these results. 639 Stewart and Rogoff 588 

 found that the output of epinephrine from the adrenals in 

 their animals was the same during shock as under normal 

 'conditions but, as we have seen (Chapter VI), their values for 

 the normal are probably too high. According to other in- 

 vestigators epinephrine secretion is increased during shock. 547 

 In any case, these results would not prove the existence of any 

 relation between the adrenal medulla and the development of 

 shock. 



Rich 519 subjected normal and adrenalectomized animals to 

 uniform intestinal manipulation and showed that the time 

 required for the production of shock and the character of the 

 blood pressure curves were the same in both cases. These 

 experiments indicate that excessive epinephrine secretion is not 

 responsible for the development of shock, but they do not 

 exclude the possibility that the cortical hormone is involved. 



