for two or three days, and then less frequently until normal tonicity of the intestine has returned. If from the paralysis of the intestines gas is pressing on the diaphragm and interfering with the heart, a second dose of the hypophysis preparation may be given within a few hours after the first.

If after a laparotomy or after parturition the bladder does not act and is semi-paralyzed, pituitary injections are of benefit. It is also of value, both when given hypodermatically and by the mouth, in incontinence of urine both in adults and in children, and it sometimes acts very satisfactorily in nocturnal incontinence.

In diabetes insipidus which seems so frequently due to hypophysis disturbance, hypodermatic injection of posterior lobe extracts often act almost as a specific, causing the output of urine to be decreased, the urine to be of higher specific gravity, and thirst to be stopped, and at the same time the headache which so frequently accompanies this condition ceases. This preparation or any preparation of the pituitary will not have this satisfactory action if given by the mouth. Also this treatment, even hypodermatically, does not cure the condition unless the pituitary becomes normal in its activity; consequently the injections must be repeated.

Some vasomotor disturbances may be due to dysfunction of the pituitary, and neuralgias, weariness and muscular weakness may be due to such a condition, and may be helped by administering by the mouth extracts of the whole gland. When the mother, after parturition, does not gain her strength and is weak and miserable, there may be pituitary deficiency, and pituitary feeding, associated with other proper treatment will benefit her.

It is possible that some cases of epilepsy, especially in children and youth, are due to dysfunction of the pituitary, probably associated with disturbed function of other glands, perhaps more especially of the parathyroids. In appropriate cases administration of preparations of the whole gland should be

tried.

Even when pituitary preparations seem positively indicated, if extracts of the whole gland are long given there is likely to

be an increase in the formation of uric acid, and joint pains may occur. Consequently the results of such treatment should be carefully watched.

The exact cause of rickets is still not known, although it is apparently a mistake of nutrition, but probably not entirely one of privation. It has not been shown that disturbance of the thymus gland is related to rickets. It also has not been shown that disturbance of the anterior lobe of the pituitary body is a cause of rickets, but it is a fact that this portion of the gland is closely related to the formation of solid bone. Consequently, in the disease of rickets, besides administering cod liver oil and phosphates and good nutritious food, anterior pituitary extract should be tried.

I

Administration.-The official Hypophysis Sicca is prepared from the posterior lobe of the pituitary body of cattle. It occurs as a yellowish or grayish powder, which is only partially soluble in water, and the dose is 0.03 Gm. (11⁄2 grain). The official preparation Liquor Hypophysis is a solution containing the water soluble principle or principles of the fresh posterior lobe of the pituitary body of cattle. It occurs as a transparent liquid, the dose of which is 1 mil (15 minims). As hypophysis solutions are generally used hypodermatically only, this preparation is hardly necessary, as sterile ampules are better. These ampules are made in two strengths, and contain 12 mil or 1 mil of diluted posterior lobe extract. Tablets made from the posterior lobe may be obtained, each representing 110 of a grain of its active principles. When administering these posterior lobe preparations symptoms of depression may develop. Consequently the patient should be carefully watched during such

treatment.

Preparations of the whole gland may be obtained, also preparations of the anterior lobe. Tablets of the anterior lobe represent 2 grains of the gland, and tablets of the whole gland may be obtained that represent 1 grain. These preparations also may be obtained in powder form. The frequency of the dose of any of these preparations depends upon the rapidity of the action desired. Generally the condition is chronic, and one or at most two daily doses are sufficient, and when the

minute amount of the secretion of this gland that circulates in the blood daily is considered, it will be seen that the dose to be administered should be small.

SUPRARENAL GLANDS

Description. Besides the adrenal glands, which are situated over the kidneys, there is likely to be small supernumerary suprarenal tissue scattered along the spermatic vessels in the male, on the broad ligaments in the female, and in various parts of the abdomen. Just how active this supernumerary suprarenal tissue may become after the adrenal glands have been destroyed has not been determined, although they may hypertrophy.

The adrenal gland is composed of the cortex and the medulla. The cortex is embryologically related to the genital system and as far as its function is understood, this portion of the adrenal glands is closely related to the development of the sexual organs. Macleod notes that the evidence of such relationship is shown by the fact that with sexual precocity there is hypertrophy of the adrenal cortex, that it is hypertrophied during pregnancy, and that it is poorly developed in sexual deficiency. The medullary portion is composed of masses of cells richly surrounded by blood. In these cells are characteristic granules which stain readily with chromic acid and are termed chromaffin cells. The medullary portion of the adrenal is embryologically related to the sympathetic nervous system. Function.—Animals may survive without the medullary portion of the glands, but complete extirpation of the adrenal glands is fatal to most animals. The symptoms begin on the second day after extirpation, and are weakness, both of the muscles and of the circulation; lowered temperature; dyspnea; and finally convulsions and death. If one-eighth of the total amount of the gland is retained the animal may survive, but transplants of adrenal tissue and the feeding of suprarenal extracts are not life-saving, according to Macleod.

Shäfer and Oliver first showed that there was a bloodpressure-raising principle furnished by the suprarenals. This principle is produced in the medullary portion of the gland, and

is variously known as epinephrine (Abel's name) suprarenin, adrenin, and adrenalin. This principle has been obtained in crystalline form, and chemically is closely related to tyrosine. Epinephrine is chemically an amino acid derivative, and may be made synthetically. Injection of minute doses of epinephrine will cause a rise in blood-pressure, due to the constriction of the arterioles, and will slow the pulse, due to action on the vagus center. The vessels of the splanchnic area are most influenced by epinephrine, but the large vessels near the heart are not much affected on account of the absence of muscular tissue, and the coronary vessels have been thought not to be contracted in most animals. With large doses dilatation of the vessels instead of contraction is caused, and dilatation at times rapidly follows constriction and may be dangerous. There may be a slight dilatation of the pupils when an epinephrine solution is applied to the eye. The salivary glands and the mucous glands of the mouth and pharynx are stimulated by it, and epinephrine, when injected, disturbs the glycogen function of the liver so that hyperglycemia and glycosuria occur.

Herter and Richards were the first to note the relationship of the suprarenals to glycosuria, and from their investigations and those of others we must conclude that perfect glycogenic function depends upon the proper relation between the secretion of the suprarenals, the secretion of the pancreas, and the function of the liver, and if any one of these three organs is disturbed, sugar may appear in the urine. If too much epinephrine secretion reaches the blood, glycosuria is likely to occur, apparently due to a stimulation of the liver to increase its output. of glycogen.

An extra amount of glycogen in the blood (if not too much) is a stimulant to muscle energy, and the whole body is stimulated. The glycogen function of the suprarenals is largely under the control of the nervous system and is related to the pituitary secretion. Stimulation of the thyroid may cause a stimulation of the adrenal glands, the reason that so frequently in Graves' disease there are evidences of hyperadrenalism.

The suprarenal glands are seriously affected in toxemias, whether the toxemia is caused by infecton or by the absorption

of poisons from some focus within the body. Prolonged infection exhausts the suprarenals and causes the depression and shock so frequently seen in serious illness, and repeated toxemias completely prostrate, so to speak, the adrenal glands. On this account coal-tar or other depressant drugs should not be given in prolonged illness, and not at all in a condition that soon leads to depression. This is typically true in influenza, and many a patient is seriously, if not fatally, injured by adding coal-tar or aspirin depressants to the prostrating infection of the influenza germ. Pneumococcic infection and the toxins of diphtheria are also depressant to the adrenals. Insufficient adrenals at any time cause the patient to have a weakened defense against any infection.

Although it has lately been concluded that a continuous discharge of epinephrine from the adrenal glands is not necessary for the maintenance of normal blood-pressure, still when necessity calls for an extra rise in blood-pressure and extra energy, the adrenals immediately furnish the needed extra secretion which for a time causes contraction of the abdominal vessels and raises the blood-pressure.

Meek' suggests that the cortex of the adrenals may supply a hormone necessary for life by virtue of its maintaining muscular and vascular tonus, and that the medullary portion supplies a particularly active pressor substance, epinephrine, to be used in times of emergency, and as a general body stimulant. In the vasomotor disturbances there is generally suprarenal insufficiency, and a patient who faints easily has an insufficient epinephrine secretion. This type of patient is readily shocked.

Sergent's test of adrenal sufficiency, by noting the color by gently stroking different parts of the body, is difficult to read in border-line cases, and as the color varies so in different parts of the body, it is not a test of any great importance, especially as it depends so much upon the character of the skin, the method of stroking, and whether, or not, there is a tendency to urticaria. Pigmentations on the body tend to show that the suprarenals are in trouble, and that they will soon become insufficient, unless the cause of their irritation is removed. Lowered suprarenal 1 Endocrinology, July-Sept., 1917, p. 305.