354 THE DISEASES OF THE SUPRARENAL APPARATUS 



as we have discussed in Basedow's disease, that these centers are primarily 

 in a state of hyperirritability on grounds that are not at all clear. If this 

 were so, we could speak of a true neurosis. 



Wiesel was the first who referred the disease process associated with 

 hypertonia to a condition of hyperfunction of the chromafnn system. He 

 found hyperplasia of the chromaffm tissue in twenty-two chronic and some 

 acute cases of nephritis, and in a case of aortic insufficiency all cases 

 showed cardiac hypertrophy the hyperplasia affecting the suprarenal me- 

 dulla as well as the paraganglia. Later Schur and Wiesel tried to demonstrate 

 in such cases the increased amount of adrenalin in the blood, by means of the 

 Ehrmann-Meltzer reaction. The hyperplasia of the chromafrin tissue was cor- 

 roborated by numerous authors, of whom are named Schmorl, Goldzieher, and 

 Molnar and Comisatti. Both Schmorl and Goldzieher also found an increase in 

 the adrenalin content of the suprarenals. Other authors, as Bittorf, found no 

 such hyperplasia. Certain negative cases do not seem to me to mean very 

 much, as not every case of hyperplasia need be distinct. The statements as 

 to the increased adrenalin content of the serum have met with more contra- 

 diction. It is certain with the following my own experiences agree that 

 in numerous cases with hypertonia the frog's-eye method fails. But also 

 other fine biological methods give negative results, for Schlayen, using Meier's 

 vessel-strip method, and A . Frankel, using the myographic method, found the 

 serum of nephritics even less active than normal serum. These behaviors 

 were complicated by the foreign serum, as Schlayer ascertained, in a manner 

 that could not be overlooked. The myographic method is, however, from its 

 very nature hard to interpret, for Fleming and /, also on the use of an adrenalin 

 Ringer-solution, saw inhibition of the movements and the tonus of a rabbit's 

 uterus. O'Connor, using the Laewin-Trendelenburg frog muscle method came 

 to like results. He found that the activity of the serum was conditioned not 

 only by its adrenalin content but also by other substances, that first get into 

 the serum on coagulation. We therefore can say only that up to the present 

 the biological methods do not furnish a certain evidence for the increased 

 adrenalin content of the serum. On the strength of this, however, I do not 

 feel justified in denying the teaching of Schur and Wiesel. In favor of it 

 speaks in addition to the hyperplasia of the chromafnn tissue the increased 

 diuresis, which agrees with the increased amount of sugar in the blood as 

 shown by E. Neubauer and also, as I believe, with alterations in the distri- 

 bution of the blood as seen in experimental hyperadrenalinemia. Very 

 frequently we see congestive conditions in the lungs, in the brain (retinal 

 hemorrhages, apoplexies), and in the liver. In beginning decompensation 

 very often the swelling of the liver is the- first to appear. Again, in such 

 conditions, very often at the beginning, we see a slight grade of hyper- 

 globulia; later the count of red blood cells is very often reduced (destructive 

 effect of chronic adrenalinizing on the ery thropoiesis) . Finally we find the 



