112 THE ADRENALS AND THE RESPIRATORY BLOOD-CHANGES. 



logical conclusion available, therefore, is that only a portion 

 of the blood is directly involved. We can thus account for the 

 cases of hrcmatoporphyrinuria in which apparently normal 

 health is present though the reserve of suprarenal tissue is 

 steadily being destroyed by some morbid process and brought 

 on by an intercurrent disorder in which a toxic action prevails: 

 sulphonal, trional, lead, rheumatism, gout, etc., and particularly 

 hepatic disorders, in which cloudy swelling and fatty degen- 

 eration are so prominent. 



What is the nature of the process? Kast and Weiss, 88 

 in their study of the ha3molytic effects of sulphonal upon the 

 blood, state that under certain pathological conditions, and 

 especially in anaemic women, "there exists a loose combination 

 of the blood-pigment." The same remark is applicable with 

 insufficiency of the suprarenal glands as the underlying factor 

 of the hasmolytic process, on the condition, however, that the 

 suprarenal glands be recognized as producing a secretion en- 

 dowed with the marked affinity for oxygen which it is now 

 known to possess, and that this affinity be considered a part 

 of the process. It is clear that deficiency of suprarenal secre- 

 tion must carry with it "a loose combination of the blood- 

 pigment," since oxidation, as shown by the character of the 

 reducing agents required to disintegrate blood in vitro, repre- 

 sents the principal bond of union between all the main bodies 

 involved. With both organs diseased, such a condition of the 

 blood is always more or less marked, and, when an acute toxic 

 intercurrent process suddenly appears, this "loose combina- 

 tion" becomes accentuated in proportion to the intensity of 

 the morbid effects upon the glands. If these effects are over- 

 whelming, the "blood is everywhere scarlet," to use Rabuteau's 

 expression in reference to his oxalic-acid cases; if they are 

 not, the clinical picture presented is that of the cases reported, 

 in which the original disease shows more or less marked tend- 

 ency to pervert the characteristic suprarenal symptoms that 

 appear when only one pathogenic factor is present. Here, 

 however, an additional source of blood-disintegration appears 

 on the field. 



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



