42 SURGICAL SHOCK 



adrenalin (i.e., i in 500,000 of their solution, which 

 is I in 1000). I have used this method, first, to 

 find whether there is any evidence that the blood 

 is flooded with adrenalin during a surgical operation ; 

 and second, to estimate the relative quantity of 

 adrenalin left in the suprarenal glands after death 

 from shock. In two cases a hypodermic syringeful 

 of oxalated blood was withdrawn from a vein towards 

 the end of the operation, and diluted with sufficient 

 saline to fill the glass cylinder containing the spiral 

 strip. In neither case was any adrenalin contraction 

 recorded. 



It may be objected that there would not be suffi- 

 cient adrenalin in the circulating blood of the patient 

 to react even to so delicate an adrenalinoscope as 

 one detecting i in 500 million, but calculating from 

 the supposed quantity in the human suprarenals, 

 5 mgrams according to Battelli, it is difficult to 

 believe that the glands could be exhausted in an 

 hour or two and yet the amount in the blood escape 

 recognition. 



More convincing, perhaps, are observations on 

 the suprarenal glands of patients dying from shock. 

 These were removed as soon as possible after death 

 (from six to twenty-four hours), packed and trans- 

 ported in ice, cut open in 15 c.c. of normal saline, 

 and the medullas thoroughly scraped out. Various 

 dilutions in normal saline were then tested in the 

 adrenalinoscope to determine the highest dilution 

 giving a definite rise of the lever. In four cases of 

 shock, tested against controls, there was no reduction 

 of adrenalin in the suprarenals. In fact, the patient 



