220 THE PITUITARY, THYROID AND ADRENALS AS A SYSTEM. 



effects on the muscular coat of the intestines is the result of 

 suprarenal overactivity induced by the current seems clear. 

 But these experimental data simultaneously show, since the 

 great splanchnic nerve includes branches from the fifth thoracic 

 ganglion and filaments which have been traced up to the first 

 ganglion, that the impulses to the adrenals were transmitted 

 from the upper thoracic region. 



That the cervical ganglionic chain should be the normal 

 continuation upward seems obvious. Yet, the spinal and 

 cervical nerves, which likewise connect the portion of the 

 sympathetic above the ganglion from which the first branch 

 of the greater splanchnic is given off, with the cord, must also 

 be taken into account; otherwise the impulses might be 

 thought to originate in the latter. Section of the sympathetic 

 system in the neck, therefore, will alone demonstrate whether 

 it is totally independent of the medulla before the pituitary 

 lobe is reached. 



Jaboulay's 58 operation for exophthalmic goiter, in which 

 this procedure is resorted to, is instructive in this connection. 

 In his first case section of the nerve on one side at once caused 

 cessation not only of the excessive heart-action and of the 

 exophthalmos, but also of the trembling. But recurrence took 

 place within a few weeks. That such should be the case seems 

 normal if the pituitary plays a prominent part in the disease, 

 since the only result of the operation was to reduce the ex- 

 cessive activity of one of the adrenals while the still overactive 

 pituitary could throw the brunt of its stimulating energy upon 

 the remaining one. In a case operated by Gayot 59 both nerves 

 were divided below the middle cervical ganglion on the left 

 side, and, above this ganglion, on the right. The exophthal- 

 mos completely disappeared on the same day and the cardiac 

 pulsations were markedly reduced. 



Since then many operations have been performed with 

 more or less success. Anzilotti, 60 for instance, in eleven cases, 

 in which the superior or middle ganglia were removed, always 

 obtained reduction of the exophthalmos, goiter, and tachycar- 



68 Jaboulay: Lyon Medical, March 22, 1896. 



Gayot: Lyon Medical, July 26, 1896. 



*> Anzilotti: La clinica moderna, No. 7, 1898. 



