342 THE DISEASES OF THE SUPRARENAL APPARATUS 



renal apparatus and especially the chromaffin tissue is well an important cause 

 of the cardiac insufficiency. In such cases the suprarenals show an essential 

 reduction in their adrenalin content (Comessati, Schmorl, Goldzieher) . 



Finally we must mention a rare finding of v. Recklinghausen's. In an 

 eighteen-year-old dwarf who died in convulsions, he found what was apparently 

 a very chronic tuberculous change of both suprarenals. I shall have occasion 

 to refer to this case later. 



Pathological Physiology of the Suprarenals. The thesis established by 

 Brown-Sequard that the extirpation of both suprarenals led to the death of 

 the animal experimented on has met with much contradiction. The sure 

 knowledge that the cortical system and chromaffin tissue are in like manner 

 important for life was first mentioned by later investigators (I mention only 

 Biedl, Hultgren, and Anderson) who took into consideration the presence of 

 accessory suprarenals. 



Biedl could at the same time furnish important demonstration that the 

 death of the animal was not to be blamed on the operative shock due to 

 injury of the sympathetic nerve plexus, as the operation also ended fatally 

 after transplantation of the suprarenals under the skin. After extirpation 

 of both suprarenals, the animals, after a latent period, showed increasing 

 apathy, adynamia, paresis, and emaciation. Blood-pressure and bodily 

 temperature gradually sank, so did also the amount of blood sugar (Forges, 

 Bierri, and Malloisel). Injection of phloridzin would now produce no 

 glycosuria or only minimal glycosuria (Eppinger, Falta, and Rudinger) ; the 

 glycogen rapidly disappeared from the liver and muscles (Forges), there 

 existed a higher sensitivity for poisons (O. Schwarz), the blood seemed to act 

 toxic, death occurring in convulsions. The symptom picture shows great 

 similarity with the peracute case of Addison's disease. We have not as 

 yet a sufficient explanation as to the question as to which symptoms of 

 Addison's disease are to be referred to the absence of the medullary system 

 and which to that of the cortical system. Before I enter into this question, 

 I will briefly mention the most important facts we know as to the physio- 

 logical significance of these systems. 



The active constituent of the chromaffin tissue is adrenalin. After the 

 important preliminary researches of v. Furth, it was first isolated in a crystal- 

 line form by Takamine and Aldrich. 



Later investigations of Aldrich, v. Furth, Pauli, et al., then led to the 

 establishment of its chemical formula. It is a methylaminoethanol pyro- 

 catechin, with the formula CgHuNOs. 



Stolz first succeeded in making optically inactive adrenalin synthetically, 

 and Fldcher then obtained the separation into the dextro- and sinistro- 

 adrenalins. The sinistro-adrenalin is far the more active and is identical 

 with that produced in the body (A bderhalden) . Probably the organism 



