344 THE DISEASES OF THE SUPRARENAL APPAR ATI'S 



of adrenalin may be increased by stimulation of the suprarenal nerves (Biedl, 

 A sher) . 



The assumption that the activity of the chromamn tissue and the excita- 

 bility of the myoneural junction (Bayliss and Starling) is regulated by cen- 

 ters lying in the medulla oblongata is essentially based on the knowledge 

 that "puncture glycosuria" is brought about by dissemination of adrenalin 

 by means of the chromafhn tissue. Already Blum had supposed this. Ep- 

 pinger, Falta, and Rudinger further pointed out concerning this that in the dog 

 without a thyroid, "piqure" may remain as ineffective as injection of adrena- 

 lin. After A . Mayer had established the fact that " piqure " remains ineffect- 

 ive in rabbits after bilateral removal of the suprarenals. Waterman and 

 Smith tried to demonstrate an adrenalinemia by means of the insufficient 

 Ehrmann's reaction. The question was first entirely cleared up by the inves- 

 tigations of R. Kahn. This author could show that after the sugar-puncture, 

 the tingibility of the suprarenals to chrome stains in great part disappears 

 and the contents of adrenalin markedly diminish. Cutting of the splanch- 

 nic nerves not only prevents the occurrence of " piqure" glycosuria, as Claude 

 Bernard had shown, but also the coming about of any change in the suprarenal 

 medulla. It should be noted that in rabbits the right suprarenal is supplied 

 by the right and left splanchnic, the left by the right splanchnic only. 



We will now consider the path that adrenalin takes in the body. The 

 blood in the cava, containing the adrenalin, first reaches the right heart and 

 then the lungs. The pulmonary vessels act refractory to it; hardly any 

 adrenalin is consumed here (Brodie and Dixon). From the lungs it reaches 

 the left heart and from this the greater circulation. The coronary vessels 

 of both sides of the heart are dilated by it, hence the heart is better permeated 

 with blood (Langendorf) . That part of the adrenalin-containing blood which 

 flows through the brain, also hardly loses in its adrenalin contents; the 

 cerebral vessels are dilated (Gerhardt) . On the contrary there occurs a marked 

 consumption of adrenalin in the other peripheral capillary territories of the 

 body, especially the muscles and the intestines (Elliott, Carnot and Josserand, 

 Falta and Priestly) . It therefore is to be assumed that the blood proceeding 

 from these organs (veins of the extremities, portal veins) is adrenalin-free 

 or at least poor in adrenalin. Therefore it is very striking that the test of the 

 arterial and venous blood as to its adrenalin contents by means of the known 

 biological methods (frog eyes, strips of vessel, uterus method) in the experi- 

 ment of Falta and Fleming showed just as strong an action, if indeed not 

 stronger, of the venous blood (extremity). On the contrary, after the subcu- 

 taneous injection of adrenalin, the arterial blood showed stronger action. 

 We must therefore be very cautious in the interpretation of the biological 

 methods mentioned, as the pressor action of the blood serum must depend 

 on other, as yet unknown, factors, a view that is also upheld by O'Connor. 

 I shall have something to say later as to the value of the biological methods 



