DUCTLESS GLANDS AND NERVOUS SYSTEM 31 



absent of a marked hyperglobulia. This also occurs in typical myxedema 

 so far as it remains uncomplicated by pathological correlations, for ex- 

 ample by a tetany. I believe, however, that we would not be just to the 

 complex relationships if we were to draw from the result of such functional 

 tests a conclusion as to the condition of excitability of the whole sympathetic 

 or the whole autonomous group. In this respect I would not subscribe to the 

 views of Eppinger and Hess so far as these views are concerned with diseases 

 of the ductless glands. These are based chiefly on the observations that in 

 individuals in whom adrenalin work's diuretically, the action of pilocarpine 

 remains absent, and reversely that in individuals who show a strong pilocar- 

 pine reaction, adrenalin does not produce glycosuria. The absence of a 

 glycosuric action of adrenalin does not show that the entire sympathetic 

 group is hyposensitive. Adrenalin acts as a raiser of blood-pressure, accel- 

 erates cardiac action, acts as a diuretic, produces aneosinophilic hyperleu- 

 cocytosis, etc., etc. The glycosuric action is only a partial manifestation of a 

 very manifold action-complex. Besides this, hyperglycemia and consider- 

 able increase of the respiratory quotient can occur without glycosuria, 

 if diuresis does not come in the way; and besides, perhaps glycosuria may 

 remain absent in cases where the consumption of sugar is high. We saw, for 

 instance, in the acute stage of tetany, absence of glycosuria in spite of enormous 

 vascular action. In other cases we may observe marked glycosuria, while 

 the vascular and cardiac action remain almost entirely absent. In bronchial 

 asthma I never saw glycosuria after the injection of adrenalin; the hyper- 

 eosinophilia which was often present was, however, diminished markedly. 

 Also the other active ductless glandular extracts, as for example thyroidin, 

 show such a dissociation of their action. 



The relations are rendered still more complex by the fact that individual 

 organs are innervated by furthering (fordern] as well as inhibitory fibers of 

 the same group. As Elliot has shown, adrenalin in minimal doses produces 

 vascular dilatation, and only in large doses vascular contraction. Pitui- 

 trinum infundibulare increases the peristaltic wave-movement of the gravid 

 rabbit uterus. The same extract acts for the most part inhibitory on the 

 virginal rabbit uterus. I can therefore agree with Eppinger and Hess 

 when they assume a relative preponderance of the autonomous innervation 

 in an insufficiency of the chromaffin tissue. -But even in Addison's disease 

 (perhaps through failure of the cortex, perhaps through other as yet obscure 

 factors) there may occur acute, highly complex conditions of excitement in 

 the vegetative nervous system. 



In many later works there is found the tendency to distinguish between 

 vagotonic and sympathicotonic conditions in ductless glandular diseases. 

 For instance, Adler supposes after the failure of the sexual glands a sympa- 

 theticotonic condition, on account of the fact that he found glycosuria in cer- 

 tain castrated individuals after the injection of relatively small doses of adrena- 



