ADRENAL INSUFFICIENCY AND BLOOD-DISINTEGRATION. 109 



in the muscular tone, the dilation and valvular incompetence 

 entirely disappeared, leaving a normal heart." 



It is only occasionally, and, in fact, very rarely, that hsem- 

 atoporphyrinuria is sufficiently marked to give the urine the 

 cherry-red or even pinkish color observed in these cases. The 

 coincidence of sufficiently advanced suprarenal insufficiency 

 and the administration of the remedy is likewise rare, especially 

 in presence of the fact to be shown later on that suprarenal 

 disease is only traceable to conditions in which toxics of various 

 kinds, including toxins, have given rise to serious general dis- 

 ease. When the adrenals or their center are normal, it is prob- 

 able that only excessive or large doses of sulphonal or trional 

 can produce a marked degree of hgematoporphyrinuria. Kast 

 and Weiss 82 produced it twenty-five times out of one hundred 

 experiments in rabbits, but only by means of large doses. In 

 dogs they could not bring it on, notwithstanding repeated and 

 prolonged experiments. 



If, as thought by Garrod, "the haBmatoporphyrin of the 

 .body has hemoglobin for its parent-substance," how does it 

 become dissociated from the latter? Chemically, they are, so 

 to say, only two reactions apart: When hemoglobin is treated 

 with an acid or a strong alkali, hsematin: i.e., methaemoglobin, 

 is formed; when the latter in turn is treated with sulphuric acid, 

 it is deprived of its iron and becomes iron-free haematin: i.e., 

 hematoporphyrin. The general belief that the drug acts 

 directly upon the blood is obviously untenable; indeed, it seems 

 hardly reasonable to expect that a few 15-grain doses, admin- 

 istered twenty-four hours apart, will produce upon the seven- 

 teen pounds of blood in the organism effects which in the 

 laboratory are only obtained with sulphuric acid or an equally 

 active reagent. In fact, Kast and Weiss 83 were totally unable 

 to obtain hematoporphyrin from extravasated blood by means 

 of sulphonal, notwithstanding the use of several processes. 

 With vulnerable organs, such as the diseased adrenals, to bear 

 the brunt of the toxic process, on the contrary, a logical con- 

 nection is established between the violent phenomena witnessed 

 and the comparatively benign exciting cause. The many con- 



82 Kast and Weiss: Berliner klin. Wochenschrift, July 13, 1896. 



83 Ibid. 



