The Surgical Treatment of Essential Hypertension


My experience in the surgical treatment of hypertension began 23 years ago when I performed a unilateral adrenalectomy for this disease. The operation was followed by a temporary fall in the blood pressure which later rose again to the preoperative level. This partial, temporary success suggested adding to the unilateral adrenalectomy the partial resection of the other gland. The blood pressure was affected somewhat more than by the unilateral adrenalectomy alone, but it again rose to the disease level.

The adrenal glands, like the thyroid gland, are endowed with the power of compensatory hypertrophy but since the adrenal glands are essential to life, it is not safe to risk the onset of adrenal deficiency by extending the operation beyond a certain limit. If too much is excised, adrenal deficiency will follow; if too little is removed, restoration of the disease will follow. Therefore, a direct attack upon the adrenal gland would seem to be excluded. However, the marked effect of the removal of adrenal tissue in these early cases of hypertension indicated that the adrenal glands and the sympathetic system, when in a state of pathologic physiology, possess the power of affecting part if not all of the energy possessed by the muscles of the arterial tree from the aorta to the capillary bed. We, therefore, attempted to attack the function of the adrenal glands by denervating the glands in two seances. This procedure improved the effect upon the hypertension, the improvement or cure in some cases having lasted for. . .



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