ADRENAL INSUFFICIENCY AND BLOOD-DISINTEGRATION. 107 



meconium, while Stokvis 76 found it in bile and Taylor and 

 Sailer 77 in blood collected post-mortem. As to its origin, 

 Garrod refers to the observations of Keyser, 78 who found "that 

 a change of diet from red meat 'to white meat without vege- 

 tables caused the disappearance of the normal trace from the 

 urine, but that it returned when green vegetables were added 

 to food/' This is in accord with Stokvis's view, that a part 

 of the urinary pigment is derived from the food and that even 

 chlorophyl, from which a very similar pigment may be ob- 

 tained, may contribute to its formation. Garrod does not be- 

 lieve, however, that the bulk of the urinary or faecal haemato- 

 porphyrin has such an origin, though he found it associated 

 with milk diet in one case, and states that it may be found in 

 the faeces of sucklings. He is inclined to favor the view, there- 

 fore, that haematoporphyrin in excess is an indication of haemol- 

 ysis, and considers that "we are justified in concluding that 

 the hcematoporphyrin of the body has hcemoglobin for its parent- 

 substance" Still, when the question is put to the test "by 

 examining the blood in cases in which unusual amounts of the 

 pigment are being excreted and by examining the urine in 

 cases in which active haemolysis is known to be in progress," 

 he finds them to "return the same answer: viz., that there is 

 no necessary connection between excess of haematoporphyrin 

 in the urine and excessive haemolysis." In pernicious anaemia, 

 "a disease in which haemolysis is an essential feature, urinary 

 haamatoporphyrin is not increased unless complicating conditions 

 are present""* 9 



This conclusion, when analyzed in connection with the 

 data we have so far submitted concerning the relations be- 

 tween the suprarenal glands and haemolysis, is fully sustained. 

 Sulphonal, trional, and other toxics capable of giving rise to 

 haematoporphyrinuria seem only to do so when the suprarenal 

 glands or their centers are more or less diseased, the amount of 

 pigment in the urine corresponding in a measure to the degree 

 of insufficiency present. Disease of both adrenals may exist, as 



78 Stokvis: Zeitschrift fur klin. Med., Bd. xxviii, p. 1, 1895. 



77 Taylor and Sailer: Contributions from the William Pepper Laboratory; 

 quoted by Garrod, loc. cit. 



78 Keyser: Dissertation, Freiburg, 1897. 



79 The italics are our own. 



