ADRENAL INSUFFICIENCY AND BLOOD-DISINTEGRATION. Ill 



parallelism between the haematoporphyrinuria and the haemo- 

 globin that had ceased, it was that with the red corpuscles, 

 since "the percentage of haemoglobin" as taken by Dr. Oswald 

 in this case "was 49 per cent." Thus, while this ratio was very 

 low, the blood-corpuscle ratio was exceedingly high: a fact 

 easily accounted for by the persistent vomiting which repre- 

 sents one of the striking features of the case, and doubtless 

 due to effusion of blood-serum into the stomach through the evident 

 engorgement of central vascular trunks. The loss of fluids sim- 

 ply condensed the blood; hence the high corpuscular ratio. 

 But for the vomiting the blood-examinations would probably 

 have given results very similar to those of the other cases men- 

 tioned. In truth, the blood-count furnishes but little, if any, 

 reliable information in any case of haematoporphyrinuria, un- 

 less the ingestion and loss of fluids by the gastro-intestinal and 

 urinary tracts and the skin be accurately established, supported 

 by a specific-gravity ratio of blood taken from a large vessel. 

 The same cannot be said of the haemoglobin ratio, which sel- 

 dom exceeds 70 per cent, while the cherry-red urine is present, 

 and often reaches below 50 per cent. 



Are we dealing with a stage in the dissociation of haemo- 

 globin, or with a reaction in which only a portion of the blood 

 is involved? To consider, as previously implied, the formation 

 of haematoporphyrin as a stage in the haemolytic process would 

 implicate an antecedent reaction: i.e., that affording methaemo- 

 globin as end-product. But in none of the reported cases which 

 have come to our notice so far is the chocolate-colored urine 

 said to have preceded the port-wine-red urine. When the latter 

 fades off, it does not assume the typical color of methaemo- 

 globinuria, but becomes dark claret, then light claret, pinkish 

 in hue, etc. In other words, it presents a totally different 

 aspect, and it is evident that it does not characterize a stage 

 of blood-disintegration of which the following are the steps: 

 Haematoporphyrin -f- iron = methaemoglobin; methaemoglobin 

 -f proteids = haemoglobin. Again, haematoporphyrin being 

 iron-free haematin, we cannot, as was the case with methaemo- 

 globin, grant it the power to take up the oxygen with which 

 life is maintained. Side by side with the impaired blood-ele- 

 ments there must exist approximately-perfect blood. The only 



