THE ANTERIOR PITUITARY AS THE ADRENAL CENTER. 227 



dent when we realize how rapidly the cardiac functions are 

 impaired as soon as a violent toxic has brought on suprarenal 

 insufficiency: the source, we now know, of the phenomena 

 that portend a fatal issue. 



Schmiedeberg, we have seen, found that the cardiac arrest 

 brought on by digitalis was "not of the nature of a paralysis, 

 but of a spasm"; that the brunt of the action of this drug is 

 exercised upon the right heart has been observed by several 

 able clinicians, Germain See among them. The meaning of 

 this fact is obvious: digitalis is probably the most perfect car- 

 diac stimulant of our pharmacopoeia, but only because better 

 than any drug it enhances the activity of the anterior pituitary 

 body, which, in turn, so stimulates the suprarenal glands as to 

 bring them to their highest functional possibilities. The 

 unusual amount of its secretion, dissolved in the plasma, 

 reaches the cardiac cavity, and there produces what experi- 

 mental physiology has shown it to always cause in muscular 

 tissues: i.e., contraction. 



A review of known facts concerning the effects of digitalis 

 on the heart shows the active part played by the adrenals in 

 the phenomena witnessed. A large dose, one capable of bring- 

 ing on marked suprarenal overactivity, occasions an enormous 

 rise of vascular pressure. Wood says that the arterioles of 

 a frog's web or of the mesentery of a rabbit undergo such 

 marked contraction that their lumen is almost obliterated. The 

 cardiac systole is "abnormally strong," the ventricles becoming 

 white when the blood is being forced out. Germain See, von 

 Openchowski, and others have emphasized the fact that this 

 action is greatest on the right side of the heart. The pulse 

 is at first slowed, strengthened, and hardened; then becomes 

 dicrotic: a suggestive fact, a primary warning, perhaps. At 

 this time, indeed, the stage of suprarenal insufficiency may 

 suddenly appear, i.e., the supposed "cumulative" stage, and 

 death occur the result of exhaustion of the suprarenal center, 

 with arrest of the heart in diastole. If this does not occur at 

 once, "ventricles and auricles no longer beat together"; one 

 portion of the heart is dilated while the other contracts. 

 Wood 70 says, in this connection: "In the 1'ast period of the poi- 



70 Wood: Lot-, cit. 



