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fingers — scabies — sulphur" will not be as useful to his country as one who studies and analyzes his problems as they arise. LIMITATIONS IN OUR KNOWLEDGE OF EPINEPHRINE. A critical review of the vast amount of pub- lished material on theories and experimental work upon the suprarenal glands clears the ground for Where Can I Buy Cheap Cialis continued action upon the problem of their importance. Rogoff (Liberation of Epinephrine from the Adrenal Glands, Journal of Laboratory and Clinical Medicine, January, 1 9 18) presents the few facts that have so far been established in animal experimentation, and states even their failure to throw any definite light upon the functional questions involved. 464 EDITORIAL ARTICLES. (New Yoik Medical Jouemal The existence of an active substance secreted by the glands and its nature as a blood pressure raisin.tc principle liave long been subjects of investigation and have gradually become estab- lished as facts. Furthermore the ability of this substance to produce the same effect upon sym- pathetically innervated structures as that caused by Where Can I Buy Cheap Cialis electrical stimulation of their nerve supply has been clearly demonstrated. This knowledge permits the use of certain of these structures for the detection and estimation of epinephrine. A delicate test is obtained with a segment of rab- bit's intestine, which, when brought into contact with blood containing epinephrine, is inhibited in tone Where Can I Buy Cheap Cialis and contracts, while a segment of uterus Where Can I Buy Cheap Cialis used to corroborate the presence of epinephrine, manifests the opposite effect, or increase in tone. It is important to discover whether the adrenal glands discharge into the blood passing through them a substance which influences the blood pressure in the same way in which it is affected by extracts of the glands. Blood may therefore be withdrawn from the adrenal veins and ap- plied to biological test objects or injected into the circulation of another animal. Both of these methods have indicated the presence of epine- phrine as a secretion product during stimulation of the splanchnic nerves. By careful elimination of other factors, it has been found that rise of blood pressure was produced when the adrenal veins were left open while the splanchnic nerves were stimulated, and no effect appeared when these veins were clamped off. Eye reactions under the same condition of liberation or non- liberation of adrenal Where Can I Buy Cheap Cialis blood confirm the same result. Spontaneous liberation of epineplirine, without artificial stimulation, forms the next question for demonstration. A smaller rise of blood pressure is caused by adrenal blood in the absence of splanchnic stimulation, while section of the splanchnic nerves produces a marked diminution {jf the effect of the secretion. Careful collection of the adrenal blood in a vena cava pocket and its subsequent release into the circulation per- mitted the determination of the rate of blood flow through the adrenals and of the liberation of epinephrine. Spontaneous liberation was no longer detectable after complete section of the nerves supplying the adrenals, while it could be Where Can I Buy Cheap Cialis reinduced by electrical stimulation of the cut ends of the nerves. No experimental proof has been given that the liberation is increased by trauma or other experi- mental conditions, nor any reliable evidence that increased secretion results from emotional dis- turbances, asphyxia, and other such influences. It may be that changes thus resulting in the cir- culation may alter Where Can I Buy Cheap Cialis the concentration of epine- phrine in the blood, but this need not indicate a change in the rate of liberation. Careful experi- ment by the author has thus far shown no such change. The symptoms of apparent in- creased action of epinephrine in animals under the influence of fright can be elicited when the epinephrine supply is almost or entirely cut off Animals in which the epinephrine supply is re- duced to a very small amount or is even impossi- ble of detection continue to live in excellent health and to respond normally to emotional disturbances. The emergency function of the adrenals has not been established. The dependence of sugar mobilization upon the epinephrine output cannot be substantiated since experimental hyperglyce- mia can be produced by usual means even when epinephrine has been reduced to a minimum. It is probable, from the condition and behavior of cats with practically no epinephrine secretion from the adrenals, that this substance is not ab- solutely essential to life and health. It may be. but thi3 has not been proved, that chromatin tissue throughout the body liberates epinephrine and also that there is some other substance nec- essary to life in the secretion of the adrenals. The limited state of knowledge, Rogoff points out, of so potent a substance as epinephrine, should render any clinician very cautious in re- sorting to adrenalectomy or other measures of relief, until more extensive and conclusive in- vestigation has been accomplished. DOES THE CARREL-DAKIN METHOD Cn^E US A NEW TREATMENT? Probably the first, certainly the most insistent, problem which the military surgeons of France and England were called upon to solve was such