94 THE ADRENALS AND THE RESPIRATORY BLOOD-CHANGES. 



accounted for, and, if the cutaneous tissues do not show pig- 

 mentation, which they sometimes do; witness the cases re- 

 ported hy Bouchard and Ponzet 45 and perhaps the yellowish- 

 amber pigment of alkaline haematoporphyrinuria, that pig- 

 ment should be present elsewhere, at least in some cases, since 

 the urine of chlorotics is usually pale, though copious. We 

 have ample evidence that some unaccounted-for substance ac- 

 cumulates in the blood of chlorotics, in the frequency of throm- 

 bosis as observed in these cases. The researches of Leichten- 

 stein 46 have shown that thrombi can occur in practically any 

 part of the organism, but particularly in the lower extremities 

 (phlegmasia alba dolens) and the cerebral sinuses. Eeview of 

 the literature on this subject soon shows that the nature of 

 these thrombi has remained unascertained and the "peculiar 

 yellowish-green" pigmentation of the skin likewise. Stengel, 47 

 alluding to the latter, says: "The pigment is doubtless altered 

 haemoglobin, but its exact nature is unknown." That acid 

 liosmatoporpliyrin is the basis of all these forms of pigmentation 

 seems to us probable. In the blood of chlorotics this may (but 

 secondarily, owing to alkaline surroundings) be transformed into 

 alkaline hcematoporphyrin, and this yellowish or amber pigment 

 account for the peculiar hue of the skin. In Addison's disease 

 a melanin probably a derivative of haemoglobin, but a more 

 stable pigment, owing to its probable absorption into tissues 

 and deposition as a catabolic product into the melanoblasts 

 accounts for the bronzing. 



But how and why is chlorosis so frequently cured with 

 iron? Chlorotics do not always recover under the administra- 

 tion of iron, and other agencies hygienic and medicinal will 

 sometimes bring on cure where iron has failed. We are there- 

 fore not dealing with a disease invariably associated with a 

 quantitative deficiency of this metal, but one in which it is 

 not properly assimilated. Its effects must, therefore, be in- 

 direct and be addressed mainly, at first, to hasmatogenic func- 

 tions, provided the gastro-intestinal tract does not by inade- 

 quacy too greatly limit absorption. An increase of red blood- 



46 Bouchard and Ponzet: Trans. Ninth Inter. Congress, 1888. 

 M Leichtenstein: Miinchener med. Wochenschrift, 1899. 

 * 7 Stengel: "Text-book of Pathology," edition, 1900. 



