650 THE INTERNAL SECRETIONS AND IMMUNITY. 



corresponding deficiency of oxidizing substance in the blood. 

 Among the organs stimulated by the oxidizing substance, or 

 rather awakened to physiological activity by the injections, 

 are those of the adrenal system itself; so that the adrenals 

 per se, by resuming their functions, continue the beneficial 

 effects of that injected into the blood. That this stimulation 

 actually occurs may easily be shown. 



Lobar pneumonia, a disease in which the adrenals seem 

 to be stimulated to a much higher degree than in diphtheria, 

 is attended, as is well known, by marked leucocytosis. If, as 

 previously suggested, this phenomenon is the result of adre- 

 nal overactivity, it seems reasonable to conclude that when 

 it is present the adrenal secretion must simultaneously be 

 increased. The following lines quoted from Osier's "Practice of 

 Medicine" 29 are significant: "There is in most cases a leuco- 

 cytosis which appears early, persists, and disappears with the 

 crisis. The leucocytes may number from 12,000 to 40,000 or 

 50,000 or even more, per cubic millimeter. The fall of the 

 leucocytes is often slower than the drop in the fever, particu- 

 larly when resolution is delayed. The annexed chart from J. S. 

 Billings's paper 30 shows well the coincident drop in the fever 

 and in the number of leucocytes. A point of considerable 

 prognostic importance is that in malignant pneumonia the leu- 

 cocytosis may be absent, and in any case the continuous ab- 

 sence may be regarded as an unfavorable sign. Of 50 cases 

 shown in my clinic during the sessions of 1896-97 and 1897-98, 

 the lowest was 10,200." Von Limbeck noted this coincidence 

 in 1889. 



It is plain that if a high degree of leucocytosis indicates 

 a correspondingly high rate of adrenal overactivity and the 

 fever follows the same fluctuations, the glands must also un- 

 derlie the production of the latter phenomenon. 



That this is the case may be shown in another way. We 

 know that lobar pneumonia is sometimes afebrile in children 

 and drunkards. The weakness of the adrenals of the former 

 has been already referred to; one of the most marked results 



'Osier: Third edition; article, "Lobar Pneumonia." 

 J. S. Billings: Johns Hopkins Hospital Bulletin, No. 43. 



