Series of fifteen cases of ha•moglobi nuric fever, defined as an acute febrile disease. probably of malarial origin, and characterized by the occurrence of an extensive and rapid hamolysis. Hear sey (Brit. Med. Jour., Jan. 26, 1901).
2. It may be caused by extensive burns, insolation, transfusion of lamb's blood and occur as a symptom of severe infectious diseases (scarlatina, typhoid fever, diphtheria, intermittent fever, icterus). Hxmoglobinuria has been ob served by Winckel as a special disease of the newborn. In severe malarial fevers with icterus, hxmog,lobinuria has often been noticed; these fevers occur mostly in tropical climates in the three conti nents; when the patient returns to a temperate climate the lilemoglobinuria ordinarily ceases; the cases may be light or severe; the severe cases end lethally either by exhaustion, by complete cessa tion of the secretion of urine or by caus ing a urTinic condition of the patient.
Case of luenioglohinuria of hiematog coons origin from the effects of an intra uterine washing with carbolic acid.
On the eleventh day the patient died, after a number of rigors having appeared on different days. On section there was found a putrid endometritis and acute parenchymatous nephritis, with infarc tion of the urinary tubules with hem oglobin. Krukenberg (Centralblatt ftir Gynlik., Aug. 1, '91).
Three cases of transient bremoglobin uria from muscular exertion. In two the cause was a foot-race; in the third, a game of lawn-tennis. The blood was healthy, but the corpuscles were de stroyed by some product of the unusual muscular exertion, probably carbonic acid. L. Dickinson (Brit. _lied. Jour., May 19, '94).
Malarial hmmoglobinuria is due to de mineralization of the blood caused by morbid changes in the liver from ma laria. Small doses of quinine, just enough to destroy the plasmodium, and subcutaneous injections of ride solution, to antagonize destruction of red corpuscles, are indicated. Tous saint (La Presse6d., No. 41, 1901).
3. Hamoglobinuria is caused by dis solution of blood, i.e., in scurvy, purpura, rubrum maculosus, variola hremor rhagica, and may also be seen in typhus.
4. The intermittent, or paroxysmal, haemoglobinuria is a distinct affection which has especially been studied in the last years. It has commonly been ob
served in men, seldom in women.
[Armand, Sircdey, and Gamier (Bull. MM., '95) relate a case of paroxysmal hremoglobinuria in a woman 37 years old. F. LEvisox.] The attacks, which have already been described, vary much in frequency, are usually traceable to exposure to cold, especially of hands or feet. The disease is characterized by intermittent disso lution of the red corpuscles of the blood during the attacks. Ehrlich proved this by placing a ligature around the finger of a patient and exposing it to cold; in healthy persons this procedure does not alter the composition of blood, but in patients suffering from paroxysmal hemoglobinuria the blood drawn from a finger treated in this way will be dis integrated, the blood-corpuscles will be broken up, and the limmoglobin dis solved in the serum, which therefore has a pink instead of a yellowish color.
Case of paroxysmal hmuloglobinuria which was apparently caused by sudden exposure to cold water in bathing, and which subsequent examination showed to be due to cold, as the blood of a ligated finger which had been exposed to freezing was greatly disintegrated and not unlike that found in the urine. Sweet (New Zealand Med. Jour., Oct., '96).
During the attacks the number of the red corpuscles is diminished; after the attack many small red corpuscles and hiematoblasts appear in the blood.
1. Illemoglobinuria is rarely pure; it is generally accompanied by a real destruc tion of red blood-corpuscles at the mo ment of the attack.
2. The loss of haemoglobin greatly sur passes the loss of red corpuscles, as in one case the loss of hemoglobin equaled of the normal, while the loss of red corpuscles only equaled one-ninth of the normal.
3. The resistance of the blood is much diminished at the time of the attack. It is found that the red corpuscles de stroyed at the end of twenty-four hours during the attack are equivalent to one third of the total count, while during the normal state not one-quarter of the normal count is destroyed.