[Six papers on the posterior pituitary hormone and the parasympathetic nervous system] / by Harvey Cushing.

  • Harvey Williams Cushing
Date:
[1931?]
Catalogue details

Licence: Public Domain Mark

Credit: [Six papers on the posterior pituitary hormone and the parasympathetic nervous system] / by Harvey Cushing. Source: Wellcome Collection.

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    conceivably have had some bearing on the intensity of the reaction. However, other persons without pituitary adenomas and with normal third ventricles prove to be equally susceptible to the effects of the in- jection. As might be expected, due partly to individual idiosyncrasy of the sub- jects of these tests as well as to the variety of intracranial disorders by which they were victimized, and due partly to possible differences in the activity of the commercial preparation employed, precise standardization of which is difficult, considerable variability in the intensity of the re- sponses has been observed from case to case. In one patient a cubic centimeter of “obstetrical pituitrin’’ gave no reaction whatsoever. In another, the customary cubic centimeter of ‘‘surgical pituitrin” gave only the slightest reaction; but two days later 1.5c. cm. gave a severe reaction with the usual pronounced flush, sweating, vomiting, salivation and lachrymation with fall in temperature of 5.9°F. within two hours. In this particular instance, shivering accompanied the fall in body tempera- ture and, contrary to the usual rule, there was a rise in the metabolic rate. Ordinarily the rate falls, a drop from —27 per cent to —50 per cent having been observed in one patient with a chromophobe adenoma. No characteristic pupillary reaction has been detected in any case. Observations on blood sugar, on blood fat, on the erythrocyte count, have not been as yet sufficiently numerous or sufficiently striking to justify an attempt to interpret them. The expected haemodynamic response has in most cases been surprisingly slight and brief or altogether absent even when the reaction has been otherwise marked; when it has occurred there has usually been a slight slowing of the pulse. There has almost always been a temporary oliguria but the effect on the excretion of urine has been obscured by the fact that the tests have been made on fasting patients with considerable loss of fluid from vomiting and sweating. The injection in all cases has been made into the lateral ventricle and the question naturally arises as to the way in which the extract acts when thus introduced. Two possibilities suggest themselves: (1) Resorption into the blood stream; and (2) the direct stimulation of hypothalamic nuclei by diffusion of the substance through the ependymal lining of the third ventricle. The former is highly improbable not only because of the promptitude of the reaction but for the reason already mentioned, that pituitrin when injected into the blood stream or intramuscularly has a vaso constrictor effect and causes cutaneous pallor whereas vaso-dilata- tion with flushing and hyperhidrosis are evoked by its intraventricular injection. Other evidence of a more negative character, which will be reserved for a subsequent paper, speaks in favor of the view that the ex- tract must act as a direct stimulant to subependymal hypothalamic nuclei. In three patients who have previously shown a marked reaction to
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