HEMOGLOBINURIA.
Definition.—Evacuation of urine con taining the coloring matter of blood (but no corpuscles).
Symptoms.—The urine varies in color from smoky to pink or red, sometimes almost black; the color has been com pared to that of porter, coffee, or port wine. The urine is ordinarily turbid, acid, of variable specific gravity, and highly albuminous; it deposits after some time an abundant, chocolate-colored, grunions sediment, which microscopic ally is seen to consist chiefly of granular limmoglobin, mixed with renal casts, hyaline and fatty, sometimes also with crystals of htematoidin, uric acid, and oxalate of lime; occasionally a few cor puscles of blood may be found. The presence in the urine of haemoglobin, or more correctly of methcemoglobin, is demonstrated by different tests, as Hel ler's test, the guaiac test, the microscop ical examination, and spectral analysis (see H1E141ATURIA). By spectral analysis two absorption-bands are found between 1) and E and a third between C and D of the Franenhofer lines.
or paroxysmal, limmoglob inuria is characterized by attacks of hammglobinuria separated by free inter vals of days, weeks, or months. Two attacks have rarely been observed in one day; they are ordinarily caused by cold, especially to exposure of hands or feet (Davy, 1llniri, Lichtheim, Rosenbach). The attacks last from three to twelve hours, and are preceded for a brief pe riod by a chill or rigor, itching of the skin, languor, a sense of weight or dull pain over the kidneys, aching pain or stiffness in the legs, and nausea or vomit ing. Shivering sets in and generally there is fever with rise of temperature to 40° C. (104° F.) and still higher. The fever continues for some hours and ends with profuse perspiration. The attacks are sometimes followed by an eruption of urticaria. The urine, which was normal before the attack, becomes dark and re mains so during some hours, after which it gradually resumes its normal appear ance. The liver and the spleen have in most cases been found swelled and tender. After the attack the patient is very much exhausted for some time, the skin and the mucous membranes being pallid.
There are three stages in the produc tion of Inemoglobinuria: Alteration of the blood (pre-existing) ; alteration of circulation (paroxysmal); kidney lesion (usually only functional). The blood
changes may affect the corpuscles or the plasma. The globules become in part disintegrated and the haemoglobin es capes. The alteration in the plasma consists of a power to cause dissociation of the hemoglobin from the corpuscles. The circulatory changes are produced by vasomotor disturbances and induce paroxysms by causing hinoglobincemia. The kidney lesion consists of a tempo rary loss of the property possessed by the epithelium of the convoluted tubules of decomposing the haemoglobin and sepa rating the iron. This kidney lesion is essential to the appearance of limmo globinuria. Ettore Chiaruttini (Archivio per le Sci. Med., vol. xxiv, No. 1, 1900).
Etiology.—llmmoglobinoria can ex perimentally be caused by injection, into the veins of animals, of dissolved hmmo globin or of substances which grate and dissolve the corpuscles of blood, such as water, glycerin, and the salts of the bile-acids; the same result may be obtained by inhalations of arseniureted hydrogen, sulphureted hydrogen, ether and other poisons, or by ingestion of poisons such as arsenic, chlorate of po tassium, etc.; transfusion of blood or serum of another species of animal also causes hmmoglobinuria.
1. In man hamoglobinuria is caused by poisons: i.e., sulphuric acid, hydrochloric acid, arsenic, chlorate of potassium, py rogallic acid, naphthol, nitrobenzol, poisonous mushrooms, etc.
1Carre (Bull. Gen. de They., '92) con tends that large doses of quinine are capable of producing a condition of metlilemoglobinuria. F. LEvisox.] Two cases of llinoglobinuria in which the patient became suddenly ill with jaundice and hoemoglobinuria. The lat ter lasted three days, then the urine became normal. Jaundice and distinct swelling of the spleen continued for seven days longer and the aspect of the case in general was that of an acute infection. No micro-organism could be found in the blood; but the patient had eaten blood-sausage the evening before his illness, and it is not unlikely that intoxication occurred in this way. Klemperer (Charite .Annalen, 20, p. 131).