THE ADRENALS IN DISEASE AND POISONING. 33 



orrhage in the lungs in 16, in the spleen in 41, in the thyroid 

 in 13, in the thymus in 11, in the kidneys in 8, in the liver in 

 5, and in the spinal cord in 5. All this further emphasizes the 

 practical bearing of the postulate: "Vessels supplied with a 

 muscular coat and capillaries are antagonistic in contraction 

 and dilation." 



On the whole, it appears to us that the mechanical phe- 

 nomena that attend fluctuations of suprarenal functional ac- 

 tivity are of surpassing importance in pathology as will be 

 shown in subsequent chapters. For the present it seems per- 

 missible to submit the following conclusions: 



1. Insufficiency of the adrenals is followed by engorgement 

 of the central vascular trunks and depletion of the peripheral capil- 

 laries, as indicated ~by general pallor. 



2. Overactivity of the adrenals causes contraction of the cen- 

 tral vascular trunks and engorgement of the peripheral capillaries, 

 as indicated ~by general peripheral hypercemia, which assumes the 

 stage of "fever" when toxics accumulate in the blood-stream. 



THE ADRENALS IN THEIR RELATIONS TO DISEASE AND 

 POISONING. 



EFFECTS OF TOXINS ON THE ADRENALS. Do poisons of 

 various kinds, venoms, or bacterial toxins cause primary in- 

 sufficiency by a direct action upon the suprarenal structures 

 or do they cause it indirectly through an influence upon the 

 nervous centers of these organs? We have seen that experi- 

 mental physiology conclusively shows that the adrenals are 

 provided with a reflex mechanism corresponding to that of true 

 glands, and that electrical stimulation of the suprarenal branch 

 of the splanchnic nerve can cause increase of secretory activity. 

 These facts, considered simultaneously, suggest that the pres- 

 ence of an unusual proportion of toxic elements in the blood 

 may, physiologically, so affect the nervous centers of the ad- 

 renals as to increase the functional activity of the latter. On 

 the other hand, ample post-mortem evidence is available to 

 show that tubercular, cancerous, and other morbid processes 

 may find in the organs a soil of activity. It is evident, there- 

 fore, that their structure is vulnerable from both directions: 

 i.e., that disease, poisons, etc., can assail them indirectly 



