Chapter XIX 



SURGERY OF THE ADRENAL 



Besides the complete excision of the adrenal glands, de- 

 scribed in Chapter VIII, a number of other surgical procedures 

 have been utilized for the experimental study of these glands. 

 In order to simulate the condition obtaining in Addison's 

 disease, efforts have been made to reduce the cortical tissue 

 sufficiently to induce a chronic deficiency of the vital hormone 

 without causing death from acute insufficiency. Partial ex- 

 cision of the glands has been performed with this purpose in 

 view. The results, however, have been unsatisfactory for the 

 regenerative capacity of the cortical tissue soon leads to hyper- 

 trophy of the remaining fragments and the resumption of 

 normal adrenal function. 413, 571 - 582 - 594 



Destructive lesions have also been produced experimentally 

 by the injection of bacteria, bacterial toxins (diphtheria, tet- 

 anus, pneumococcus, streptococcus, e£c.), 482 or chemical sub- 

 stances (arsenic, mercury, chloroform, phenol, etc.). 52 The 

 lesions of the cortex produced by these substances have al- 

 ready been discussed in Chapters III and XVII. 



Martinotti 441 first observed the marked histological changes 

 occurring in the adrenal after ligation of the lumbo-adrenal 

 vein, and subsequent workers have utilized this procedure in an 

 attempt to produce a chronic functional insufficiency. 184 - 248> 273 

 Ligature of all the vessels to the adrenal will usually result in 

 a rapid onset of an acute adrenal insufficiency. In cats, how- 

 ever, there exists a direct vascular connection between the 

 adrenals and the kidneys and if this channel for venous drainage 

 be left untied, one can produce a degree of chronic insufficiency. 

 KoudintzefT 269 ligated the efferent vessels of dogs. His animals 

 survived 16 to 24 days, had an elevated temperature, lost 

 weight, and died in convulsions. 



278 



