110 THE ADRENALS AND THE RESPIRATORY BLOOD-CHANGES. 



tradictory physiological effects observed with sulphonal as well 

 as with other drugs in this connection, and the multiplicity 

 of causative agents which may give rise to haematoporphy- 

 rinuria, are likewise accounted for. On the whole, it seems 

 reasonable to conclude that, while hcematoporphyrinuria may 

 ~be caused in normal subjects when excessive doses of the toxic 

 agency enter the Uood, it may lie caused by small doses when the 

 adrenals or their center are diseased, the intensity of the effects 

 varying with the dose and the degree of insufficiency the adrenals 

 have reached. 



In support of this view we have, in a proportion of cases, 

 besides the symptoms of suprarenal insufficiency, a more or less 

 marked reduction of haemoglobin. F. Miiller 84 reported a case 

 in which the haemoglobin ratio fell to 45 per cent, during the 

 most active stage of haematoporphyrinuria and gradually re- 

 turned to 85 per cent, as the urine became gradually cleared 

 of its pigment. The parallelism between the percentage of 

 haemoglobin and the variations in the urine is well illustrated 

 in a case reported by J. Calvert, 86 probably suffering from 

 tuberculous adrenals, with an acute exacerbation of supra- 

 renal insufficiency of unknown origin, no sulphonal or trional 

 having been taken by the patient. The haemoglobin percentage 

 was at first 48 per cent, and the red corpuscles 2,292,000. 

 Gradually the haemoglobin reached 62 per cent, and the red 

 corpuscles 3,968,000, these changes covering a period of six 

 days. "After this," says the author, "the percentage of haemo- 

 globin and the number of the red corpuscles steadily increased 

 and the urine gradually returned to its normal color." 



This should not be taken to mean, however, that in all 

 cases of haematoporphyrinuria the ratios of haemoglobin and of 

 red corpuscles keep pace with the alterations witnessed in the 

 color of the urine. In Keith Campbell's admirably reported 

 case the blood-count showed throughout 7,000,000 red corpus- 

 cles, and, when breathing had become "a constant struggle" 

 and convulsions had occurred, the ratio became even greater: 

 i.e., "rather over 7,000,000." Yet in this case it was not the 



s* F. Miiller: Wiener klin. Wochenschrift, p. 252, 1894. 

 86 J. Calvert: Lancet, Dec. 22, 1900. 



