THE SUPRARENAL SYSTEM 189 



chloroform anaesthesia, a fatal termination was threatened. Similar 

 results have been observed in cardiac paralysis induced by potas- 

 sium salts (Mankowski, Winter, Thenen). 



Kothe recommends the clinical employment of an intravenous 

 injection of J to i c.cm. of a i : 1000 adrenalin solution in extreme 

 collapse ; where haemorrhage threatens a fatal termination, he 

 advises the addition of a few (6 to 8) drops of adrenalin to the 

 normal saline solution employed for transfusion. Heidenhain 

 observed that adrenalin in saline transfusions was attended by 

 favourable effects in septic peritonitis, this condition, according 

 to Romberg and Passler as well as Heinecke, arising from 

 paralysis of the vaso-motor centres. 



Diluted adrenalin solution in large quantities has been em- 

 ployed with favourable results in the cardiac inadequacy of 

 diphtheritic children (Pospischil). 



Quite recently, F. Meyer showed that the intravenous injec- 

 tion of adrenalin saline solution into rabbits poisoned with 

 diphtheria toxin and already moribund, was followed by a rise in 

 blood-pressure and in the pulse-rate, an appreciable improvement 

 in the respiration, and a return of the corneal reflex; death did 

 not supervene until seven hours later. 



In addition to its effect upon the vessels, adrenalin, as we 

 have already seen, exercises a tonic influence upon the heart 

 muscle, and for this reason its exhibition is indicated in all forms 

 of circulatory inadequacy. Kothe's dictum : " That adrenalin is 

 the most powerful analeptic which we possess " is justified by 

 clinical experience (Meissl, Rothschild, Calmann, John). 



In considering the other physiological effects of adrenalin, it 

 must be well borne in mind that this substance exercises an 

 intensifying influence upon a number of muscular and glandular 

 organs which derive their innervation from the sympathetic sys- 

 tem. Lewandowsky (1899) was the first to show that the intra- 

 venous injection of suprarenal extract into cats produces a 

 contraction of those muscles of the eye and orbit which have a 

 sympathetic innervation, and this finding was confirmed by Borut- 

 tau. Langley, and after him his pupil Elliott, next showed by 

 means of the most careful experiments, that the action of adrenalin 

 is wholly confined to tissues with a sympathetic innervation ; and, 

 moreover, that the effect of adrenalin, in any part of the body, is 

 identical with that produced by electric stimulus of the sympathetic 

 nerve supplying that part. Where the influence of the nerve is 

 stimulatory, exciting contraction or promoting secretion, the 

 action of adrenalin will also be stimulatory. Where, however, 

 irritation of the nerve is followed by inhibition, the injection of 

 adrenalin will also produce inhibition. 



Before passing to a consideration of the grounds upon which 

 this hypothesis is founded, it is proposed to give a brief summary 

 of the doctrine of the innervation of the vegetative organs, as 

 formulated by the English school of physiologists. 



