90 THE ADRENALS AND THE RESPIRATORY BLOOD-CHANGES. 



D. Fraser Harris, 32 Nakarai, 33 and Ogden 34 have collectively 

 found it in rheumatic fever, pericarditis, peritonitis, meningitis, 

 cirrhosis of the liver, croupous pneumonia, typhoid fever, 

 measles, Hodgkin's disease, exophthalmic goiter, pulmonary tu- 

 berculosis, pleurisy, leprosy, lead poisoning, and chronic poi- 

 soning with sulphonal, trional, and tetronal. 



Another important feature of these reports is that they 

 also refer to the discovery of haBmatoporphyrin in several cases 

 of Addison's disease, while D. Fraser Harris 35 alludes to a case 

 of exophthalmic goiter attended with haBmatoporphyrinuria in 

 which "some patchy pigmentation of the skin with bullae filled 

 with red, alkaline fluid" had been observed. Still another 

 point of association with suprarenal insufficiency is furnished 

 by several reported cases of peritoneal blood-effusion. If we 

 recall the various instances of suprarenal apoplexy (Arnaud), 

 followed by rupture of the organs previously alluded to, the 

 presence of adrenal disease can be surmised. Again, Stokvis 

 found that sulphotial caused punctiform hemorrhages into the 

 mucous membrane of the stomach and intestines, besides 

 haematoporphyrinuria, in rabbits. Capillary centrifugal dila- 

 tion, due to the protective overactivity of the adrenals, which 

 precedes insufficiency, and consequent constriction of the ab- 

 dominal trunks had obviously appeared: the counterpart of 

 other experiments already related in which hsematuria, epis- 

 taxis, etc., had been noticed after injections of suprarenal 

 extract. 



As to the haemoglobin ratio in these cases, the sequence of 

 chemical reactions involved in the morbid process suggest that 

 a reduction should simultaneously appear. D. Fraser Harris 36 

 refers to a case reported by Cant in which the ratio was 40 

 per cent, of normal with 2,250,000 red corpuscles evidently a 

 case in which hgemogenesis was impaired. A case of McCall 

 Anderson's, on the other hand, showed a normal number of 

 red corpuscles, while the haemoglobin was only 60 per cent, of 

 normal. In a case referred to in Campbell's paper (Oswald's), 



82 D. Fraser Harris: British Medical Journal, Feb. 5, 1898. 

 "Nakarai: Deutsches Archiv f. klin. Med., Nos. 2 and 3, 1897. 

 84 Ogden: Boston Med. and Surg. Jour., Feb. 24, 1898. 

 86 D. Fraser Harris: Loc. cit. 

 86 Ibid. 



