THE ADRENALS AND CHLOROSIS. 91 



the percentage of haemoglobin was 49 per cent. We have seen 

 the close association between hasmoglobinuria and suprarenal 

 insufficiency; it is probable that we have in haamatoporphy- 

 rinuria, therefore, an advanced step in blood-disintegration 

 connected with correspondingly advanced suprarenal disease 

 bordering on total insufficiency. This view is sustained by the 

 practically general prognostic estimate of clinicians. Refer- 

 ring, for example, to McCall Anderson's case, in which haama- 

 toporphyrinuria had recurred for years, the man being still 

 living, Harris says: "Had I not seen Prof. McCall Anderson's 

 case ... I should say this red urohaamatoporphyrinuria 

 was a most grave symptom, a precursor of a fatal issue; such, 

 at any rate, it seems to be in the case of women." 



A direct connection between haamatoporphyrinuria and 

 suprarenal insufficiency further asserts itself when the symp- 

 tomatology of cases in which the former occurs are studied from 

 this standpoint, and the morbid lesions are carefully sought 

 post-mortem. A case of haamatoporphyrinuria ably described 

 by Keith Campbell, 37 of Perth, is especially valuable in this 

 connection. The abdominal pain, muscular paresis beginning 

 at the extremities and including the diaphragm, tendency to 

 diarrhoea, Cheyne-Stokes respiration, convulsions, and coma 

 interspersed among the symptoms of the major disease (mania 

 and pulmonary tuberculosis) typify the phase of overactivity 

 bordering on insufficiency which corresponds with the sequence 

 of events in the chemical reactions referred to above. The most 

 striking feature of this case, however, is the fact that by far 

 the most marked lesions found post-mortem were in the adre- 

 nals. The report of the pathologist, Dr. W. F. Eobertson, in 

 this connection was as follows: "Right adrenal shows in the 

 cortex numerous large areas in which the epithelial cells have 

 undergone a marked degenerative change, consisting of the 

 replacement of the protoplasm by clear globules. These glob- 

 ules, which vary considerably in size, do not (with an occa- 

 sional exception) give a fatty reaction with osmic acid. There 

 is no evidence of any tubercular disease in any part of the 

 organ. Left adrenal shows similar changes. There is no 



87 Keith Campbell: Journal of Mental Science, April, 1898. 



