THE ADRENALS AND CHLOROSIS. 93 



liver, kidneys, etc., also assisting, while Macallum, 40 Kunkel, 41 

 Quincke, 42 Hall, 43 Hare, 44 and others have traced it to the 

 blood of various organs after feeding animals upon iron-con- 

 taining substances. An interesting view in this connection is 

 that of Hall, whose researches tend to show that the iron of the 

 organism occurs both in fixed combination i.e., in haemo- 

 globin and in very loose organic combination, the latter vary- 

 ing constantly with the amount of iron ingested. This would 

 coincide with the conceptions herein submitted, since they sug- 

 gest the existence of a fixed ratio of haemoglobin and therefore 

 of iron, and the onset of disease as soon as the fixed combina- 

 tion, haemoglobin, is structurally compromised. 



A striking association with the suprarenal functions also 

 appears when the disposal of iron is analyzed. The occurrence 

 of bronze spots in connection with various infections and in- 

 toxications, tuberculosis, syphilis, arsenic poisoning, etc., has 

 already been referred to, the development of this melanoderma 

 occurring in response to a multitude of abnormal factors. The 

 bronzing of Addison's disease is due, as is well known, to a 

 melanin, a pigment which contains no iron, found around the 

 vessels, and a product of cellular catabolism. Again, the hair 

 is a recognized depository for eliminated iron; and deeply- 

 pigmented hair is a characteristic of Addison's disease. We 

 thus have tangible proof that Addison's disease, the typical 

 manifestation of suprarenal insufficiency, is attended with 

 haemoglobin disintegration, and we have seen the close relation- 

 ship between this disease and chlorosis. 



But why is chlorosis not also attended with bronzing be- 

 sides the other symptoms of Addison's disease discernible? As 

 previously stated, chlorosis is herein considered as a stage of 

 suprarenal insufficiency, not necessarily organic nor patholog- 

 ically connected with Addison's disease. It is attributed in 

 most cases to physiological incompetence of the adrenals, 

 whether this be due to inadequate development or to impaired 

 nutrition. Yet, the accumulation of free pigment must be 



40 Macallum: LOG. cit. 



41 Kunkel: Archiv fur d. Gesam. Physiol., Ixi. 



42 Quincke: Archiv fur exp. Pathol., Bd. xxxvii, 1896. 



43 Hall: Archiv f. Anatomie u. Physiol., 1896. 



44 Hare: Archiv fiir Verdauungs Krank., vol., 1898. 



