116 THE ADRENALS AND THE RESPIRATORY BLOOD-CHANGES. 



process of transformation is most active when bacterial proc- 

 esses are likewise so. 



An anomalous phase of the process, however, is the fact 

 that "the quantity normally present in the faeces is far larger 

 than that which enters the intestine with the bile," while, as 

 shown by F. Miiller, "complete occlusion of the common bile- 

 duct causes urobilin to disappear from the faces, and a few 

 days later from the urine also." Garrod states that the latter 

 observation has been repeatedly confirmed. Yet, in animals 

 with biliary fistula, while no bile enters the intestine, the urine 

 still contains urobilin. In Copeman and Winston's 87 case of 

 biliary fistula, in which no bile had entered the intestine, the 

 faeces were uncolored by stercobilin; nevertheless the urine 

 still contained urobilin. But, even leaving urobilinuria out of 

 the question, it is difficult to understand how occlusion of the 

 bile-duct can govern a quantity of pigment greater than that 

 which the liver takes up: i.e., how it can affect pigment which 

 the liver has not received. This is but one instance of several 

 available. Garrod, alluding to the general conclusions sug- 

 gested by the data presented in his excellent paper, says: 

 "When, however, we apply this theory to clinical facts, diffi- 

 culties are encountered which cannot as yet be wholly met, and 

 it soon becomes evident that the theory, as above stated, is 

 inadequate, and that some amplification or modification of it 

 is necessary." This amplification seems less remote when the 

 physiological functions of the suprarenal glands are introduced 

 as factors in the process involved. 



The fact that urobilinuria is marked in diseases such as 

 rheumatism, cirrhosis of the liver, etc., in which haematopor- 

 phyrinuria is also observed, suggests a common origin. Garrod 

 refers to urobilin and its chromogen "as widely distributed in 

 the human body. . . . They have been found in the bile 

 removed from the gall-bladder during life, as well as in that 

 obtained post-mortem, and are met with in the blood and in 

 serous effusions. . . . As obtained from all the above 

 sources, specimens of urobilin agree in all their properties and 

 are clearly identical in their nature." As to the origin of uro- 



87 C. W. Purdy: "Uranalysis and Urinary Diagnosis," p. 46, fifth edition, 1900. 



