4. The so-called paroxysmal hremo globinuria being only a symptom, and not a morbid entity, it is important to examine in every case the modifications in the blood in order to find out if dif ferent varieties of limoglobinuria are associated with different changes in the blood. Vacquez and Mareano (Archives de Med. Exper., Jan., 'NB.
Case in which the hemoglobin in the urine, although it showed most of the usual reactions, on the addition of hydro chloric and acetic acids became split up into a soluble peptone and an insoluble ferric and phosphoric body, and no longer showed 'Teichmann's hasmin crys tals. Adolf Jalles (Wiener klin. Rund., July S, 1900).
Probably the paroxysms are in some cases caused by the presence of parasites in the blood; in animals (oxen, horses) a similar disease has been observed. Kro gins and von Hellens found in the blood of diseased oxen parasitic corpuscles anal ogous to the plasmodium of malaria.
Systemic origin of the paroxysmal variety of laemoglobinuria insisted upon. Lepine (La Semaine Med., Feb. 24, 'SS).
While admitting a class of humo globinurias of toxic nature due to sys temic blood solution, the paroxysmal a frigore regarded as invariably of renal origin. Hayem (La Semaine Med., Feb. 24, 'SS).
Case of Raynaucl's disease with parox ysmal humoglobinuria seen in a child of 6 years. In this case both symptoms probably depended upon excess of uric acid in the blood. Haig (Trans. Med. Soc. of London, '92).
Various authors have observed inter mittent hmmoglobinuria in connection with syphilis.
Post-mortem upon an artisan with a syphilitic history. subject to paroxysmal hmnoglobinuria, first brought on after a severe chilling three years before. The kidneys were found in a healthy condi tion except for some amount of pigmentation of the tubular epithelial cells, and a coagulation-necrosis of a number of the renal cells, causing the appearance of vacuolization. Germoing (Med. Press and Circular, Aug. 20, 'SS).
Typical case of paroxysmal Immo globinuria, which occurred in a man who acknowledged the three taints of ma larial fever, syphilis, and alcoholism. For eight years, every winter, upon the least chilling, occurred paroxysms of hammglobinuria. The paroxysms began with chilly sensations, followed by fever and sweat. Brunelle (Le Bull. Med.,
June 10, '91).
Four cases of paroxysmal haerno globinuria a frigore in children. Three of them were caused by hereditary syph ilis. Comby (Revue Internat. de Med. et de Chir., July 10, '95).
[Courtois-Sullit (Med. Moderne, '93) observed a case in a child of 5 years who showed indubitable signs of inherited syphilis. Parry (Jour. of Railway-sur geons, Fort Wayne, '94) and Gubarew (Petersburg. med. Woch., '94) also men tion cases of intermittent humoglobin uria in syphilitic patients. F. LEvisox.1 Prognosis.—In the hmmoglobinuria caused by poisons, infectious diseases, septic diseases, etc., the prognosis is de termined by the gravity of the primary disease; the intermittent hmmoglobinuria is for a long time compatible with life; the patients never die during an attack; recovery has been observed, but often the disease continues for many years.
Prognosis regarded as grave in Immo globinuria. Potain (Internat. Med. Mag., Nov., '93).
Treatment.—When hmmoglobinuria is a symptom the treatment must be di rected toward the fundamental disease; in cases connected with syphilis an anti syphilitic treatment has been of use, as well as quinine in hcemoglobinuria of malarial origin.
In malarial humoglobinuria in the eatly and free use of quinine depends the safety of the patient. As a first dose, if the temperature be above 103° F., 20 grains recommended, continuing its ex hibition in 10-grain doses every three hours afterward for twenty-four hours, then dropping to 5 grains every three hours. If quinine blindness follow, the drug is to be stopped. With each of the first two doses are combined 2 grains of calomel, followed, in ten hours after the last dose of calomel, by a Scidlitz powder.
To allay the vomiting bismuth and opium are used. Chambles (Med. Bull., May, '91).
Case of so-called essential htemoglobin uria, in a man of 35 years, cured by injections of mercury. Koster (Therap. Monat.. Feb., '93).
In every instance of bcemog,lobinuria, so-called essential, occurring in a child, the specific treatment should be em ployed even in the absence of any 'sign of hereditary syphilis. Courtois-Suflit (La 1,116d. Moderne, Mar. 2, '95).
In paroxysmal hwmoglobinuria change of climate, dietetic treatment, iron, qui nine, and arsenic have been recom mended.