THE ADRENALS, LEUCOCYTOSIS AND PHAGOCYTOSIS. 617 



structures and merely because the parietal layer is supplied 

 with nerves capable of transmitting pain-impulses. This would 

 tend to suggest that the adrenal system might underlie the 

 whole process, since increased activity of this system, brought 

 on by a generalized infection originating in the intestinal ulcer- 

 ation (a toxin acting like any other poison), would correspond- 

 ingly increase the oxyhaemoglobin ratio, and therefore enhance 

 tissue-change and leucocytogenesis in proportion. 



The effects of quinine upon the adrenal system will enable 

 us to test this question. That this alkaloid produces upon this 

 system effects similar to those caused by other sufficiently 

 active drugs may readily be ascertained. In the stage of ad- 

 renal overactivity we have cerebral and peripheral congestion, 

 manifested by headache, tinnitus, muscular agitation, convul- 

 sions, etc.; increased peripheral vascular pressure, shown by 

 the flushed face, haematuria, spontaneous epistaxis, etc.; in- 

 creased heart-action, shown by strengthened pulse-beat, with 

 lowered frequency sometimes down to 40, and other signs. 

 When the stage of insufficiency is reached, great muscular 

 weakness appears, followed by paralysis, sometimes perma- 

 nent in frogs, lowered and depressed vascular pressure, with 

 superficial anaesthesia; rapid and greatly weakened heart-beat; 

 lowered temperature; dyspnoea, with lessened C0 2 elimination; 

 methgemoglobinuria, etc. Five grains have been known to cause 

 symptoms bordering on the latter stage. This is well illus- 

 trated by a case reported by Ciaglinski, 10 credited to "idiosyn- 

 crasy": a term which may become obsolete, since the special 

 vulnerability which it serves to represent appears to be due 

 to functional impairment of the adrenal system. The untoward 

 symptoms occurred in a girl of 22 years, after a dose of only 

 5 grains. One hour after this was taken there suddenly devel- 

 oped agonizing pra?cordial and periumbilical pain, obstinate 

 nausea, repeated vomiting and diarrhoea, with profuse, offen- 

 sive stools of a black color. At the same time her body and 

 extremities became covered with patches of urticaria. The 

 rash disappeared spontaneously. The pulse was rapid, the 

 pupils contracted, and there was marked tenderness of the 



10 Ciaglinski: Gazeta Lekarska, No. 13, 1892. 



