THE ADRENALS, LEUCOCYTOSIS AND PHAGOCYTOSIS. 623 



inal substance is introduced into the circulatory tree, this sub- 

 stance will remain without effect as long as it will only circulate 

 in the arteries and veins. It will only begin to manifest its 

 activity on reaching the capillaries, and in them bathe the 

 anatomical elements upon which it especially acts." As we 

 view the process, of course, it is the toxic that is acted upon 

 by the anatomical elements: the reverse, therefore, of Claude 

 Bernard's view. 



The application of our interpretation to Eussel's typhoid- 

 fever cases the six in which details are furnished may fur- 

 ther serve to elucidate the whole question. Why did Mrs. V., 

 Case III, die notwithstanding surgical intervention? On the 

 sixteenth day of the disease her leucocyte-count showed 6100. 

 Evidently the ulcerative process was already far advanced; the 

 blood was markedly filled with pathogenic elements, and the 

 adrenals were nearing the stage of insufficiency; hence the low 

 leucocyte ratio. The prevailing view as regards the diag- 

 nostic value of leucocytosis in respect to perforation suggesting 

 safety in this direction, it was only when the classic signs of 

 perforation suddenly developed that cceliotomy was resorted 

 to. The leucocyte ratio was then 4800: evidence that the 

 adrenal system had lost ground. The patient died because the 

 functions of this system had become so compromised by the 

 toxaemia that her entire vital mechanism, through the imperfect 

 Hood oxidation involved, had become correspondingly inadequate. 

 The toxaemia having overcome her adrenal system, the pro- 

 tective processes in the capillary, serous, hepatic, etc., cellular 

 elements not only failed, but all her functions, including that 

 of leucocytogenesis in the bone-marrow, spleen, etc., likewise. 

 Briefly, her adrenal system stood as the foundation of her life's 

 mechanism, i.e., the underlying factor of her oxygen-talcing powers 

 and of her autoprotective functions, and dissolution followed when 

 it failed her. 



Four of the cases submitted to operative procedures that 

 showed a high leucocyte-count namely: 28,000, 12,000, 14,500, 

 and 17,000 recovered. The sixth case, however, showed a 

 blood-count ranging from 12,000 to 14,000; but, operation 

 being delayed, it reached 32,000. Why did this patient die? 

 The very fact of the presence of so high a percentage points 



