THE ADRENALS IN DISEASE AND POISONING. 61 



vegetable diuretics, buchu and uva ursi, undoubtedly do so, 

 and it seems probable that it is only with toxic doses of their 

 active principles hydrochinone in the case of uva ursi, for 

 instance that the stage of suprarenal insufficiency can at all 

 be reached. Digitalis gives rise to very marked symptoms of 

 suprarenal overactivity, followed, when excessive doses are ad- 

 ministered, by the typical signs of insufficiency. 119 Huchard 

 aptly ascribes Petresco's remarkable results in pneumonia, in 

 this connection, to the fact that the digitalis-leaves employed 

 by him were rich in alkaline salts. The diuretic effect and 

 the continued alkalinity of the plasma thus insured must cer- 

 tainly have done much to enable him to obtain the remarkably 

 low death-rate reported: i.e., 2.06 per cent, of 825 cases 

 treated. The bearing of a reduced sodium-chloride ratio upon 

 the prognosis of this disease is well known. 



Among general remedies, the coal-tar products anti- 

 pyrin, acetanilid, sulphonal, etc. may be classed with those 

 which give rise to a short stage of excitement, attended some- 

 times, in the case of acetanilid, with copious urination. Here, 

 again, all the signs observed after removal of both adrenals 

 occur, and when anuria is absent methaemoglobinuria or haema- 

 toporphyrinuria sometimes appears. Yet the bladder must 

 always be taken into account in such conditions. Wood says, 

 for example, that this organ is completely paralyzed in ad- 

 vanced atropine poisoning. While forcible expulsion of urine 

 occurs in the primary stage, that of suprarenal activity, the 

 flow steadily decreases and finally ceases. "It rises and falls 

 with the arterial pressure," observed Meuriot 120 : a strong hint 

 that the adrenal functions are involved. 



All these facts seem to us to show that what are now con- 

 sidered as the cardinal symptoms of poisoning are, in reality, 

 manifestations of overactivity or of insufficiency of the adrenals, 

 and that the functions of these organs may le stimulated, inhibited, 

 or arrested in two ways: 



1. By a direct action of the toxic agent upon their cellular 



119 This gives us a clue to the meaning of the supposed "cumulative" property 

 of digitalis. Continued stimulation finally overtaxes the adrenals. 

 1*0 Meuriot: Quoted by Wood, loc. cit., p. 174. 



