THE ADRENALS IN DISEASE AND POISONING. 59 



and insufficiency are observed whenever the agent administered 

 is not one which tends to inhibit metabolism of the renal cellular 

 elements or to cause renal irritation in moderate doses. 



Opium, for instance, markedly inhibits metabolism; dur- 

 ing the primary stage of suprarenal activity the quantity of 

 urine is not only reduced, but complete cessation of the flow 

 is often witnessed. We simultaneously have diminished elim- 

 ination of urea and other waste-products. Copper is poisonous 

 to all forms of protoplasm; it either gives rise to suppression 

 or, if the dose be less active and anuria does not occur, it causes 

 haematuria, and the tissues, as in Swale Vincent's animals, are 

 blood-stained. Quinine occasions similar phenomena; hsama- 

 turia is brought on in some cases; methsemoglobinuria a 

 sign of suprarenal insufficiency, as will be shown in others. 

 Judging by the ratio of waste-elimination, however, urea, uric 

 acid, phosphoric acid, etc., quinine must also inhibit tissue- 

 metabolism, and as the signs of suprarenal insufficiency only 

 appear after very large doses, the anuria must be an attendant 

 symptom of suprarenal activity. The anuria due to irritation 

 may be illustrated by the effects of iodoform: a drug which 

 readily induces inflammation of the glomeruli. Iodine also 

 irritates the kidneys and causes nephritis when given in large 

 doses; but these need not be such as to cause suprarenal in- 

 sufficiency. Anuria, therefore, may appear along with violent 

 cerebral excitement, a markedly increased vascular pressure 

 and cardiac power all evident signs of suprarenal overactivity. 

 In two of our own cases iodide of potassium administered for 

 syphilis gave rise to oedema of the glottis: a localized oedema 

 of suprarenal origin. The oedema brought on by arsenic is 

 of the same kind. In large doses it reduces the excretion of 

 urea, and increases that of phosphoric acid and also 1 an im- 

 portant point in this connection that of sodium chloride. 



Alkalinity of the plasma, due mainly to the alkaline phos- 

 phates and carbonates it contains, is an all-important factor of 

 the blood's physiological functions; and the sodium chloride 

 also present serves not only to facilitate osmosis, but also to 

 preserve the solubility of the globulins. While the water and 

 possibly the other constituents of the urine are separated from 

 the blood by the glomerular epithelial cells, and not by filtra- 



