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Epinephrine is a biological preparation of great clinical and theoretical importance. Probably no other humoral agent is employed as extensively in the clinic, and certainly none is used more frequently in physiologic and pharmacologic investigations, particularly of the circulatory system. Because it generally has been regarded as a pressor substance, epinephrine has been implicated as possibly of etiologic importance in certain clinical cases of hypertension, particularly those associated with tumors of the adrenal medulla. However, with the passage of time, more and more evidence has accumulated to cast doubt upon the possibility that it is involved in the production of human essential hypertension. Thus, Pickering and Kissin (1), Fatherree and Hines (2), Fatherree and Brown (3), Gordon and Levitt (4), and others not only have questioned the role of epinephrine in the causation of essential hypertension, but also have demonstrated that patients with the disease are not abnormally sensitive to the drug as judged by changes in blood pressure and cutaneous temperature in the extremities after its administration. Meltzer and Auer (5), Elliott (6), Hampel (7), Ascroft (8), and Cannon and his collaborators (9, 10) have demonstrated in animals that degeneration of the sympathetic nerves results in an increased sensitivity of smooth muscles to epinephrine, especially following post-ganglionic as compared with pre-ganglionic section. Smith-

the journal of clinical investigation/the journal of clinical investigation

THE COMPARATIVE EFFECTS OF SMALL INTRAVENOUS DOSES OF EPINEPHRINE UPON ARTERIAL PRESSURE AND PULSE RATE IN NORMOTENSIVE SUBJECTS AND IN HYPERTENSIVE PATIENTS BEFORE AND AFTER THORACOLUMBAR SYMPATHECTOMY