612 CHEMICAL PATHOLOGY OF THE DUCTLESS GLANDS 



veiy doubtful if these observations are of significance." It has been 

 reported by several investigators that the blood in such conditions con- 

 tains sufficient epinephrin to permit of its detection and measurement 

 by its physiological effects (dilatation of the frog's iris, contraction 

 of the rabbit uterus or blood vessels, inhibition of contraction of the 

 intestine). The critique of this work by Stewart,^''' however, makes 

 it necessary to discount most of the published results, as being in- 

 adequately^ controlled. He found no epinephrin even in blood coming 

 direct from the adrenal veins, unless the gland had been stimulated 

 or manipulated, and none could be detected in the serum from several 

 patients with high })ressure from various causes, as well as in mental 

 disturbances and exophthalmic goiter. Vaso-constrictor substances 

 may be present in serum, both normal and pathological, which are not 

 epinephrin. His negative results are corroborated by Janeway and 

 Park.^" Broking and Trendelenburg,^^ using a perfusion method 

 which the}^ believe to be reliable, found a normal pressor effect from 

 the blood of persons with arteriosclerosis and high blood pressure, a 

 decrease in nephritis with high pressure, a great increase in exophthal- 

 mic goiter, and no changes in pregnancy, chlorosis and diabetes. 



Arterial Degeneration from Epinephrin. ^'^ — An interesting result 

 of repeated injections of epinephrin into animals is the appearance of 

 a marked atheromatous degeneration of the aorta, with calcification. 

 This was first observed by Josue, and since confirmed by Erb, Fischer, 

 Gouget, Loeb and Githens, and many others. These lesions are quite 

 different from those of human aortic arteriosclerosis, the chief change 

 being degeneration of the muscle-cells of the media, without any con- 

 siderable inflammatory reaction. There is, however, more resemblance 

 to the atheromatous changes seen in the arteries of the extremities. 

 They do not seem to be due to the heightened blood pressure, since 

 simultaneous administration of substances that keep the blood pressure 

 down does not prevent the atheroma from developing (Braun), while 

 other substances that raise blood pressure, such as nicotine (Josue) 

 or pyrocatechin (Loeb and Githens), do not cause atheroma. Pre- 

 sumabl}', therefore, epinephrin causes the arterial changes by a direct 

 toxic action, but the influence of increased blood pressure cannot be 

 entirely excluded. However, slow injection of epinephrin, so regu- 

 lated that there is an increase in the blood content without significant 

 rise of pressure, fails to produce arteriosclerosis.'"*" Myocardial de- 

 generation is also observed in experimental aninmls, and later may lead 

 to an interstitial myocarditis (Pearce). These experiments suggest 



14 See Pearce, .lour. Kxpcr. ^fcd., lOOS (10), 73.'): Tliomas, Zie<iler's Boitr., 

 1910 (4!)), 228. 



15 Jour. Exp. Mod., IHll (14), .377: 1012 (IT)). .147. 

 I's.Tour. Exp. Med., 1012 (16), 541. 



iTDcut. Arc'li. klin. Med., 1011 (103), lOS. 

 • i«Li(erature <riven l.y Saltykow, ("eiil. f. Tatli.. lOOS (10). 3()0. 

 ixh van T-ecrsutii and' Hassc'rs, Zeit. cxp. Pa(l\.. 1014 (Itt), 230. 



