276 CORTEX 



no evidence of any abnormal permeability of the capillaries in 

 adrenal insufficiency, as claimed by Swingle and his collabora- 

 tors, to account for the loss of blood volume which they assume 

 is the cause of the development of shock in adrenal insufficiency. 



Heuer and Andrus 295 have recently reported that the adminis- 

 tration of adrenal cortical extract controlled the shock which 

 follows the injection of aqueous extracts of closed intestinal 

 loops. Their results, however, do not appear convincing and 

 the commercial extract which they utilized is of doubtful po- 

 tency as regards its hormone content. Moreover, the fact that 

 they were unable to obtain their results after heating the ex- 

 tract to its boiling point indicates that they were deceived in 

 attributing their observed results to the hormone, for as we 

 have seen (Chapter XVI), the hormone is not so readily de- 

 stroyed by heat. 



The cause of the state of shock which ultimately develops 

 in adrenal insufficiency is still problematical. According to 

 many authors the shock is due to the loss of fluid from the 

 circulation, as described in Chapter XI. In some cases this 

 may be true, for, occasionally, an intravenous injection of saline 

 will induce a remarkable improvement in animals in severe 

 adrenal insufficiency. In most cases, however, such injections 

 are of no avail which is inconceivable if one accepts the view 

 that adrenal cortical insufficiency expresses itself solely in the 

 development of a state of circulatory shock. Other factors 

 undoubtedly play a part and, except in those cases in which loss 

 of fluid from the circulation results in a state of shock, we must 

 look upon the development of this condition in adrenal in- 

 sufficiency as an agonal manifestation comparable to that seen 

 in many other fatal diseases. 



The question finally arises as to the implication of the ad- 

 renals in the development of shock by influences other than 

 adrenalectomy. It is quite conceivable that many conditions 

 may deplete the supply of the cortical hormone from the body. 

 In such cases the ultimate development of a state of shock may 



