THE ADRENALS IN DISEASE AND POISONING. ~>~ 



contraction of the walls of all muscular vessels and of the 

 heart-muscle, followed by centrifugal pressure in the cerebral 

 capillaries almost to bursting-point: the source of the intense 

 hyperaemia found post-mortem. 



In mania a potu, in which the most violent mania pre- 

 vails, the pulse is strong, bounding, and tumultuous: an indi- 

 cation of correspondingly excessive suprarenal activity. When 

 the critical stage is reached, the first sign that the organism's 

 protective organs, the adrenals, are losing their hold, reason, 

 will, and consciousness fail, and insensibility soon follows. 

 That these organs are concerned in the production of these 

 effects is demonstrated by the marked fall of the blood-pressure, 

 and the rapid, thin, and compressible pulse. The lower limbs, 

 early in this stage, have first shown their inability to support 

 the body. "In the majority of carefully examined cases the 

 lower limbs are affected before the upper" wrote Norman Kerr 

 several years ago, though not aware that in this statement he 

 pointed to a primary sign of suprarenal insufficiency. 



Opium, we know, first stimulates mental activity and 

 procures sensations of well-being. Simultaneously, muscular 

 activity is increased slightly in man, markedly in animals. 

 In the latter, particularly, tremors and cramp-like contractions 

 true tetany are sometimes witnessed. The vascular press- 

 ure is raised, the face is congested, suffused, and sometimes 

 cyanosed, the skin being dry and warm. The heart's power is 

 increased and the pulse is correspondingly full and strong. 

 "No phenomenon of human poisoning by opium can be at- 

 tributed to its action on nerve-trunks," says Wood. 117 The 

 effects must also, therefore, be exerted upon muscular ele- 

 ments alone. When the crisis is reached, drowsiness lapses 

 into deep sleep, from which the patient is roused with diffi- 

 culty. If he is awakened, weakness and general prostration 

 are more or less noticeable. The vascular pressure is lowered; 

 pallor and cyanosis attest to imperfect oxidation; and respira- 

 tion has become distant, feeble, and shallow. The heart's 

 action is depressed and weak, the temperature low, and the 

 skin cold and moist all signs of suprarenal failure. 



117 Wood: Loc. cit., p. 125. 



