108 THE ADRENALS AND THE RESPIRATORY BLOOD-CHANGES. 



we have seen, without interfering with the general physiolog- 

 ical operations with which they are concerned until a very 

 small proportion of normal tissue is left. A demand for supra- 

 renal protective activity caused by the presence of a toxic in the 

 blood taxes this physiologically adequate remnant more or less 

 severely according to the dose and power of the toxic exhib- 

 ited. If the stage of total suprarenal sufficiency, as the result 

 of tuberculosis, syphilis, etc., is still remote, an agent, such as 

 sulphonal, may be given for a long time before it causes 'a high 

 degree of adrenal insufficiency to bring on marked haematopor- 

 phyrinuria; if, on the other hand, but a vestige of normal 

 suprarenal tissue just sufficient to sustain life only remains, 

 but a few doses are sufficient to cause it. Keith Campbell's 

 case of haematoporphyrinuria, in which the most marked mor- 

 bid change observed post-mortem was hyaline degeneration 

 of both adrenals, may again be referred to in this connection. 

 Only two 15-grain doses of sulphonal had been taken by the 

 patient. The symptoms outlined by the following broken sen- 

 tences: "Very poor circulation, blue oedema, coldness of the 

 extremities . . . markedly-paretic flexors. . . . Breath- 

 ing a constant struggle; Cheyne-Stokes breathing . . . 

 pulse rapid and thready . . . patch of rusty staining over 

 parietal region," etc., sufficiently indicate advanced suprarenal 

 insufficiency to show a direct correspondence with the post- 

 mortem findings. 



To illustrate the effects of less advanced disease of the 

 adrenals when sulphonal is used, the case recently reported by 

 E. Waldo 80 may be cited. Here the drug had been taken dur- 

 ing a prolonged period before the urine assumed the typical 

 cherry-red or port-wine-like color. The rapid pulse (180), 

 prostration culminating in general paresis, a "scarcely-moving 

 diaphragm," and other symptoms also point here to disease of 

 the adrenals. An interesting case of this kind, reported by 

 Stuart Hart, 81 was attended with marked cardiac disturbance. 

 That temporary reduction of a stimulus corresponding to that 

 attributed to the suprarenal secretion was a factor in its pro- 

 duction is suggested by the fact that "with the improvement 



80 R. Waldo: British Medical Journal, June 15, 1901. 



81 Stuart Hart: Amer. Jour, of the Med. Sciences, April, 1901. 



