1)6 THE ADRENALS AND THE RESPIRATORY BLOOD-CHANGES. 



Haemoglobinuria, with which haematuria is frequently con- 

 founded, is an entirely different condition. Keferring to the 

 former disorder, Osier 50 says: "The essential pathology of the 

 disease is unknown, and it is difficult to form a theory which 

 will meet all the facts. . . . Increased hajmolysis and solu- 

 tion of the haemoglobin in the blood-serum (haemoglobinaemia) 

 precedes, in each instance, the appearance of the coloring mat- 

 ter in the urine." Again: "The coloring matter is not haema- 

 tin . . . nor in reality always haemoglobin, but it is most 

 frequently methaemoglobin. The urine has a red or brownish- 

 red, sometimes quite black, color, and usually deposits a very 

 heavy brownish sediment." That the identity of hagmoglobinuria 

 is also a source of confusion is fully emphasized by the author. 

 Indeed, from what has been said of bronzing and if our views 

 are sound the true source of what is often termed "haema- 

 turia" or "haemoglobinuria" is, in truth, methaamoglobin or its 

 isomer haematin, a decomposition product of haemoglobin, which 

 we primarily attribute to suprarenal insufficiency. Briefly, 

 while haematuria indicates overactivity of the adrenals, haemo- 

 globinuria, methaemoglobinuria, and, we will add, hamiatopor- 

 phyrinuria, typify, in our opinion, the three downward steps 

 of suprarenal insufficiency as manifested in the blood. That 

 all these phenomena appear in the same order in the symptom- 

 atology of poisons the degree of blood-disintegration in- 

 creasing with the virulence of the toxic substance which enters 

 the blood will now be shown. 



Weir Mitchell long ago observed that, when death came 

 on rapidly after a rattlesnake-bite, the blood-corpuscles re- 

 mained intact. This is fully sustained by the need of a certain 

 time for the disintegration of blood through suprarenal insuffi- 

 ciency. Weir Mitchell also noted that, in cases in which the 

 venom did not act promptly, the corpuscles appeared altered, 

 some being dentated: one of the signs of impending disin- 

 tegration. This constitutes, in all probability, the primary 

 result of suprarenal insufficiency. With Eeichert, he subse- 

 quently ascertained that the corpuscles became spherical. 

 Brainard 51 had also noticed that they became spherical and 



60 Osier: "Practice of Medicine," p. 854, edition of 1898. 

 u Brainard: Academic des Sciences, Nov. 28, 1853. 



