HEMOGLOBINURIA, OR HEMATINURIA.
The treatment of this condition, in which blood pigment or hwmoglobin appears in the urine, should be that of the primary hnmolysis causing the destruction of the red blood discs, and the problem is simplified by recognising that the origin of the disease is independent of any kidney lesion, the albumin present in the urine being always in the form of serum-globulin. All forms of hwmoglobinuria are toxic, and the recogni tion of the poison is obviously the first step in the treatment. In the non-paroxysmal type of the disorder, one or other of the following poisons may be demonstrated to be the cause—viz., potassium or sodium chlorate, sulphuretted or arseniuretted hydrogen, carbolic or pyrogallic acid, naphthol, carbon monoxide, phosphorus, quinine, or toluylendiamin ; the symptoms may be expected to subside rapidly on the withdrawal of the drug.
The hmoglobinuria which supervenes after transfusion of the blood of the sheep, goat or the horse is of a similar nature, and is usually very transitory, requiring no treatment.
When the affection arises during the course of other diseases, as black water fever, malaria, typhus, scarlet and typhoid fevers, the primary disease will require prompt treatment.
Paroxysmal usually appears in the winter months, and follows an exposure to cold and damp. The patient should be ordered to bed at once, and should be kept warm and have a dose of Nitrite of Amyl, which sometimes, if given early, aborts the paroxysm. As the attack will pass off without endangering life, the less done by drugging the better, especially as the host of astringent substances formerly recommended possess no power over the paroxysm. Chloride
of Calcium, so beneficial in ordinary halnaturia, is useless. Quinine is still employed in malarial hxmoglobinuria, and the question of its value is discussed under ltlackwater Fever.
Arsenic is of little value during the attack, brit, like Iron, its beneficial effects are obvious and unmistakable in the anemic state which follows severe paroxysms. The hamloglobintnia of Raynand's disease is of the same nature as the ordinary paroxysmal type, and as it is usually brought on by exposure to chills and over-fatigue, warmth and rest in bed are the best palliatives. Dry cupping or hot poultices to the loins are still recommended, but as the condition is not in any war due to renal con gestion, this treatment is apparently irrational except in blackwater fever. Preventive treatment will in all paroxysmal cases consist in removal to a equable climate during the winter months, when the patient's circumstances permit.
Eason has discovered a toxin in the blood which in the presence of cold attacks the red discs, but h•inolysis does not occur till the blood has become warmed again by circulating through the internal organs. As the disease is believed by many to be of syphilitic origin, Iodides may he administered between the attacks, but Mercury is seldom indicated unless signs of active syphilis should he present.