

CONDITIONS OF HYPERFUNCTION OF THE SUPRARENAL APPARATUS 355 



count of neutrophilic cells mostly at the upper limits of the normal or even 

 slightly exceeding these. 



As to the question why interstitial nephritis is associated with an increase 

 of function of the chromaffin tissue I shall not enter into here more inti- 

 mately. In many cases, for instance, in the nephritis of scarlet fever, the 

 disease of the kidney is primary, in other cases the contracted kidney can only 

 be a partial manifestation of the general arteriosclerosis of the small blood- 

 vessels. Such a general arteriosclerosis must lead reflexly to a hypertonia 

 through lowering of the resistance, if the accessory amount of blood should 

 be driven through the capillary system of the muscles, etc. Finally it is 

 conceivable that the increase of function of chromaffin tissue (as for instance 

 in tumors of the sympathetic, perhaps also in premature arteriosclerosis of 

 diabetics, or in transition of diabetes into contracted kidney) is the primary 

 factor (Frank's hypertonic diathesis). 



Still less clear is the significance of the chromaffin tissue for the coming 

 into existence of the atheromatosis. As is known, chronic adrenalizing of 

 rabbits can produce sclerosis of the great vessels (Josue, Erb, and others). 

 This is an affection of the media. The vascular lesions in tumors of the sym- 

 pathetic are also affections of the media. Braun, however, by the intraven- 

 ous injection of minimal doses of adrenalin could produce atheromatosis of 

 the small vessels. The ordinary arteriosclerosis of the large vessels, that 

 occurs without increase of blood-pressure, has nothing at all to do with 

 the chromaffin tissue; it depends on a primary degeneration of the elastic 

 elements. 



Finally, some observations as to the influence of hyperf unction of the chrom- 

 affin tissue on the carbohydrate metabolism. In hypertonics we find, as already 

 mentioned, hyperglycemia. The kidneys adapt themselves to a very gradual 

 increasing amount of sugar in the blood, without glycosuria (v. Noorden). 

 In many cases of diabetes mellitus, and especially in advanced cases, much 

 speaks for the view that here also there is a slight overproduction of adrenalin 

 (Falta, Newburgh, and Nobel). That the administration of this escapes 

 detection by the known biological methods is not to be wondered at, when on 

 the one hand we take into consideration the unreliability of the biological 

 methods (see above) and on the other, consider what monstrous dilution, 

 i gm. of adrenalin, which under circumstances may produce much sugar in the 

 urine, must experience when injected subcutaneously in man. Such a slight 

 increase in adrenalin production may very well be overshadowed by the 

 counter-regulations without leading to increase in blood-pressure. On the 

 contrary the toxic components seem to dissociate, as is shown by the prema- 

 ture arteriosclerosis so frequently observed in diabetes. An exact histological 

 study of the same has not as yet been made. Finally we should point out the 

 frequent transition of diabetes into contracted kidney. On the grounds de- 

 tailed the negative standpoint that G. Bayer, and Broking and Trendelenburg 



