VARIATIONS IN ADRENAL FUNCTIONAL ACTIVITY. 23 



POISONS AND VARIATIONS OF THE FUNCTIONAL ACTIVITY 

 OF THE ADRENALS. We have only considered so far the haem- 

 orrhages that follow a gradual destruction of the adrenals 

 and which appear only when the fragment of medulla left can 

 no longer fulfill the organ's functions. But there are cases in 

 which, independently of any such a slow destructive local 

 process, the sudden accumulation of one or more toxics sud- 

 denly overpowers the adrenals and through the insufficiency 

 thus brought about engender secondary fatal hyperaBmia, or 

 hcTmorrhage attended with fully as violent symptoms as those 

 observed in Arnaud's case in which sudden death followed a 

 burn of the arm. Andrewes's case, in which death occurred 36 

 hours after the first symptoms of an acute disease which he 

 thought bore some points of resemblance to haBmorrhagic small- 

 pox, also illustrates this class. In fact, instances such as 

 Andrewes's have so often been noticed by clinicians that Still 54 

 has proposed a distinct category of cases in which "after an 

 acute illness lasting only two or three days, usually with a 

 purpuric or bullous eruption," death occurs, "and the supra- 

 renal lesion appears to be a part of the fatal issue." 



That general intoxication can thus act as an original cause 

 of hemorrhage has been shown experimentally. Thus, Roger 55 

 found that inoculation of the guinea-pig with a culture of the 

 pneumobacillus of Friedlander was followed by profuse hem- 

 orrhage into both capsules, the blood actually bursting through 

 the great capsular vein, or causing necrosis of the surrounding 

 elements by mechanical compression. Langlois 56 also demon- 

 strated that suprarenal haemorrhage could be brought on by 

 the bacillus pyocyaneus. Charrin 57 found that, by injecting 

 diphtheria toxins into guinea-pigs, congestion which in some 

 instances reached the hemorrhagic stage was not alone 

 caused, but he also observed that small doses used repeatedly 

 and during prolonged periods caused hypertrophy of the or- 

 gans. Petit 58 also noted, after introducing Loffler bacilli in 



54 Still: Lancet, May 7, 1898. 



K Roger: Berliner klin. Wochenschrift, Jan. 21, 1894. 



58 Langlois: Le Bulletin Medical, Feb. 7, 1894. 



57 Charrin: La Semaine Medicale, June 3, 1896. 



68 Petit: La Semaine Medicale, June 3, 1895. 



