624 THE INTERNAL SECRETIONS AND IMMUNITY. 



to extensive toxaemia with adequate adrenals, but we have here 

 an example of excessive toxin-dosage. The organs suddenly 

 failed precisely as they did in the case of poisoning with 300 

 grains of quinine, and the symptoms of collapse of the one are 

 those of the other. Since all poisons act similarly upon the 

 adrenal system, toxins must ~be similar to drugs in their effects 

 upon the adrenal system. 



As to its diagnostic value in typhoid fever, leucocytosis 

 being a protective process varying in degree (all things being 

 equal) with that of the toxaemia, it fluctuates proportionally 

 with the efficiency of the adrenals. We therefore have in leu- 

 cocytosis, not a direct sign of impending perforation, but a 

 means of gauging the likelihood of perforation through the in- 

 tensity of the ulcerative process as reflected by the toxaemia. An 

 excess of from 3000 to 10,000, therefore, points to a correspond- 

 ingly active ulceration, which may at any moment bring on 

 this complication, though the pulse show no unusual rise. Yet 

 the leucocyte-count may reach 14,500, as stated by Cabot, and 

 even far beyond, and perforation fail to occur. When, however, 

 a high ratio is reached, another source of danger appears upon 

 the scene: a more or less sudden inhibition of adrenal func- 

 tions through excessive dosage of toxins. Finally, hypoleuco- 

 cytosis may point, especially with a weak pulse, hypothermia, 

 etc., to gradually increasing reduction of adrenal efficiency 

 all signs of a vicious circle that will soon end in death unless 

 the focus of intoxication can be eradicated. These clinical 

 features show that the views herein submitted are capable of 

 standing the crucial test of practical application, and that 

 overactivity of the adrenal system is the inciting factor of leu- 

 cocytosis and therefore of phagocytosis. 



Analyzed in the light of the foregoing statements, phago- 

 cytosis might possibly be made to subserve all the requirements 

 of a function capable of protecting the organism against bac- 

 teria and other disease-breeding bodies. The endothelial lining 

 of the pulmonary alveoli alone, for example, constitutes a 

 potent barrier against the intrusion of pathogenic germs. The 

 vast surface of phagocytes arranged in perfect battle-array, so 

 disposed as to at once capture, ingest, and destroy any in- 

 truder as soon as he comes near enough to excite, by his own 



