350 THE DISEASES OF THE SUPRARENAL APPARATUS 



often for a long time. According to our experiment the subcutaneous in- 

 jection is to be preferred in not too urgent cases. 



Several times we saw, too, an astonishing result from subcutaneous admin- 

 istration (thrice 5 mg., each in one-fourth glass of water) in obstructing car- 

 cinoma of the esophagus, in which the passage was reestablished probably by 

 subsidence of the tumefaction of the inflamed mucous membrane, but such 

 results only last for a few days. Further, adrenalin was introduced by Xeu 

 into obstetrical practice. After the injection of adrenalin the uterus was 

 brought to a condition of tetanoid contraction. The drug has been especially 

 serviceable in Cesarean section. It may be injected either subcutaneously 

 or directly into the uterus. Probably pituitrin will supplant adrenalin in this 

 respect, as it has the same action and is less deleterious. 



The employment of adrenalin is also useful in phosphorus poisoning. E. 

 Neubauer and Forges observed that in animals poisoned with phosphorus, 

 the stainability of the chromafnn tissue to chromic acid disappeared; both 

 these authors attribute the vanishing of carbohydrates from the liver, the 

 subsequent fattening of the liver and the hypoglycemia (E. Neubauer, and 

 Frank and Isaac) to the falling out of the chromaffin tissue and in most cases 

 could actually prevent these symptoms by the administration of adrenalin. 



As to the treatment of osteomalacia with adrenalin, see chapter on sexual 

 glands (appendix). 



2. Isolated Symptoms due to Failure of Function of the 

 Suprarenal Cortex 



In the consideration of the pathogenesis of Addison's disease, it has been 

 pointed out that we as yet know nothing certain concerning that group of 

 cases which has as the basis of the symptom-complex the destruction of the 

 suprarenal cortex. It is true that many authors regard the manifestations of 

 intoxication that tend to enter into acute cases and in the terminal stages of 

 Addison's disease as due to deficiency or absence of the suprarenal cortex. 

 But as yet experimental pathology has furnished no certain foundation for 

 this assumption. Nor does clinical observation, as will be seen from the fol- 

 lowing, seem to me to substantiate this assumption. 



First let us consider the malformations. In anencephalus is found, as 

 has already been mentioned, in addition to anomalies in the genital organs, 

 also aplasia of the suprarenals. A pert points out that in aplasia of the supra- 

 renals the cortical defect seems to play the most important role. I mention 

 again the case of anencephalus reported by Elliott and Armour, in which the 

 suprarenal medulla and the paraganglia were intact. Again, in cases in which 

 the suprarenals are entirely absent the paraganglia may be normal, as in the 

 case of A pert. The aplasia of the cortex in the new-born is the more remark- 

 able because here the suprarenals, as is known, are especially well developed. 



