60 THE PHYSIOLOGY OF THE ADRENALS. 



tion resulting from blood-pressure, the fact remains that, when 

 the quantity of blood passed through the glomeruli is aug- 

 mented, the formation of urine can be correspondingly in- 

 creased. The enhanced blood-pressure incident upon supra- 

 renal overactivity may, therefore, become directly responsible 

 for the diuresis observed when agents other than those capable 

 of causing irritation of renal structures or of inhibiting the 

 metabolic process of their cellular elements are employed. 



These facts, collectively considered, account for the pres- 

 ence of many diuretics among alkaline salts, but they cannot 

 be included among the agents capable of causing diuresis 

 through suprarenal overactivity, because they belong to a class 

 of remedies which do not stimulate the adrenals before inducing 

 insufficiency of these organs, and the first signs of poisoning, 

 therefore, are those attended by general depression. "No dose 

 of a potash ever calls forth symptoms of circulatory stimulation 

 from the human body/' says Wood, referring to the diuretic 

 salts; and, indeed, if they do, the signs are hardly perceptible. 

 An overdose of the potassium nitrate for instance, is soon fol- 

 lowed by a symptom complex including "collapse, great mus- 

 cular weakness" . ... "with or without paralysis of the 

 lower limbs," and "suppression of the urine in some cases" 

 doubtless those in which the dose was sufficiently large. A 

 dangerous salt in this connection is potassium chlorate, which 

 suddenly brings on most violent symptoms of poisoning: the 

 exact symptom-complex following removal of both adrenals. 



It thus becomes apparent that there are two classes of 

 diuretics: i.e., those that increase micturition through stim- 

 ulation of the suprarenal glands and those that act independ- 

 ently of these organs probably, in the case of alkaline diu- 

 retics, through the increased alkalinity they bring about, and 

 liquefaction of the blood-serum they enhance. That the latter 

 factor also comes into play when the adrenals take part in the 

 process is probable. The supposed oxidizing power of potas- 

 sium salts is probably due also, though indirectly, to the in- 

 creased alkalinity which their introduction into the blood 

 causes. 



Among the true alkaline diuretics, the strontium salts 

 alone seem to cause preliminary suprarenal overactivity. The 



