366 STATUS LYMPH ATICUS AND STATUS HYPOPLASTICUS 



dilatation of the left ventricle with diffuse clouding of the endocardium, and 

 not rarely remaining behind in the development of the genitals, slight de- 

 velopment of the secondary sexual characters, retarded onset of menstruation, 

 and retarded, lessened, sexual instinct. 



According to the new researches of Wiesel and Hedinger there is regularly 

 associated with these characteristics an abnormally slight development of the 

 chromamn tissue. The medullary substance of the suprarenals is essentially 

 lessened, and the paraganglia are illy developed. According to v. Sury this 

 underdevelopment of the chromamn tissue mostly sets in after birth. 



In status lymphaticus there occurs in the blood picture a relative or ab- 

 solute reduction of the neutrophilic leucocytes and a corresponding increase 

 in the mononuclear cells, eventually also a hypereosinophilia (v. Neusser). 

 This fact is readily intelligible when the experiments of Bertelli, Schweeger, 

 and myself are considered. On the one hand it is possible that the giving off 

 of mononuclear cells of the blood is increased in hyperplasia of the lymphatic 

 apparatus, and on the other hand we must assume that an enormous trophic 

 influence is exerted on the production of the neutrophilic elements of the bone 

 marrow, this influence proceeding from the chromamn tissue by mediation of 

 the sympathetic; here the production of neutrophilic elements by the bone 

 marrow is probably diminished. 



It is very possible that this anomaly of constitution is the cause of the 

 sudden death. If the chromamn tissue is underdeveloped and not attained 

 to a great functional breadth, it may, if especial demands are made on it 

 especially by a cold bath or by the effects of narcosis of the sympathetic 

 nervous system, suddenly give out. This form of status lymphaticus may well 

 be designated an "entite morbide." The opinion has been expressed that 

 substances are given off from the lymph-glandular system to the blood path, 

 substances that in their action are in a certain way antagonists of adrenalin 

 (v. Neusser) . Also in this sense can we consider this form of status lymphati- 

 cus under the diseases of internal secretion. Such individuals, as Eppinger and 

 Hess point out, not rarely show symptoms of the relatively increased vagal 

 tonus (inclination to sweats, certain anomalies of the pulse and respiration, 

 etc.). The slight functional breadth of the chromamn tissue is, however, 

 especially important for the fate of such individuals. Often the blood-pres- 

 sure lies near the lower limits of normal, as Munzer emphasizes, the pulse 

 shows a slight force [Wurfkraft]. According to Wiesel such individuals are 

 especially predisposed to Addison's disease, in that tuberculous and other 

 processes become established in the hypoplastic suprarenal medulla, and by 

 spreading to the cortex call forth the typical picture of Addison's disease. 



The secondary form of status lymphaticus is characterized by the fact 

 that the signs of lymphatism predominate only later, the development origi- 

 nally being normal. According to the age of the individual, according to 

 whether the lymphatism is only transitory or remains permanent, does the 



