262 INTERNAL SECRETION 



trate the effects, either physiological or toxic, according to the 

 size of the dose, which result from the action of adrenalin. In 

 addition to the changes in the vessels, chronic glycosuria is 

 observed, together with progressive emaciation. The autopsy 

 shows that, in addition to the changes in the vessels and the 

 organs, there is sometimes a marked increase in the volume of 

 the suprarenals and hypertrophy of the suprarenal cortex. 



PATHOLOGICAL ADRENALIN^EMIA AS SEEN IN 



MAN. 



Neusser was the first to assume a pathological hyperfunction 

 on the part of the suprarenals. He based his conclusion upon a 

 clinical case, in which the symptoms pointed to chronic Bright's 

 disease, while the autopsy revealed carcinomatous degeneration 

 of one suprarenal capsule, together with numerous cerebral 

 haemorrhages. Neusser was inclined to regard the arteriosclerotic 

 changes and the thickening of the vessels, which Kolisko observed 

 in young persons with suprarenal affections, as results of the 

 continued high blood-pressure, brought about by suprarenal 

 hypersecretion. 



A large number of French authors (Darre, Pilliet, Vaquez, 

 Aubertin and Ambart, Josue, Widal and Boidin, Menetrier, 

 Monod and Loumeau) emphasize the fact that the hypertension 

 in chronic nephritis and in arteriosclerosis may be traced back 

 to hypersecretion on the part of the suprarenals, the latter con- 

 dition finding its anatomical expression in hyperplastic and 

 adenomatous changes in those organs. The anatomical changes 

 which they describe affect the suprarenal cortex only. 



Wiesel, w r ho was the first to inquire into the condition of 

 the adrenal system in renal diseases, found that, in all the cases 

 associated with cardiac hypertrophy of long standing, there was 

 marked hyperplasia of the chromaffine tissue in the suprarenal 

 medulla, in the solar plexus, and in the neighbourhood of the 

 left coronary artery. He assumed from this that the cardiac 

 hypertrophy present in renal affections, as well as certain cases 

 of idiopathic cardiac hypertrophy, are of suprarenal origin. This 

 discovery of WiesePs paved the way for the experiments of 

 Schur and Wiesel, undertaken with the object of demonstrating 

 the presence of adrenalin in the blood-serum of persons with 

 chronic renal disease; they found that such sera produced 

 mydriasis of frogs' eyes and gave a positive ferric chloride re- 

 action. The fact that the blood serum of persons with chronic 

 nephrosis produces mydriasis is confirmed by a large number of 

 authors (Kaufmann and Mannaberg, Goldzieher and Molnar, 

 Eichler, Comessati, Reicher, Makaroff, Miesowicz and Macziag). 

 Pal describes the frequent presence of mydriatic substances in 

 the urine of pregnant women and persons with nephritis. Accord- 



to Diem, however, the urine of persons, both with and with- 



