SURGERY 281 



gland be made at a separate operation. Judging from the 

 results of adrenalectomy in animals this would appear to be a 

 wise procedure. 



The discovery of a technique by which to differentiate the 

 androgenic tissue which gives rise to the tumors described in 

 Chapter XXIII from normal cortical tissue is very desirable. 

 Broster and Vines 95 have described such a technique but it has 

 not as yet found general acceptance. When such differen- 

 tiation shall be possible, the removal of a slice of tissue for 

 biopsy will permit an accurate diagnosis and determine the 

 nature of the operation to be performed. At present the 

 surgery of the adrenal is handicapped by the inability of the 

 operator to judge the nature of the pathological process in- 

 volved, unless there be an obvious f ungating tumor. An 

 enlarged gland which appears to be a tumor may in reality 

 prove to be a normal hypertrophied organ. The surgeon may 

 remove the greater part of a gland and yet leave a large amount 

 of the offending tissue. If the adreno-genital syndrome be 

 due to hypertrophy of the juxta-medullary androgenic zone, 

 as indicated in Chapters IV and XXIII, it would be futile to 

 remove one adrenal and part of the other to cure the condition, 

 for the remaining androgenic tissue will continue to grow. 

 Where only one gland is involved, unilateral extirpation should 

 prove adequate. When the affection is bilateral, as it appar- 

 ently frequently is, it will be necessary to devise a technique 

 whereby the internal layers of the cortex (consisting of the 

 androgenic tissue together possibly with the medulla) are 

 scooped out, leaving the normal and vital external layers of the 

 interenal tissue. 



ADRENAL GRAFTS 



Transplantation of adrenal tissue has been performed by a 

 number of investigators in both man and the lower animals. 

 Most of the attempts in the human subject were performed 

 many years ago when grafting of tissues was undertaken with 



