ILEMOGLOBT NURIA By ffiernoglobinuria is meant the discharge of the blood coloring matter in the urine. As a matter of fact, methiemoglobin will be found more often than hiemoglobin, since the latter soon changes to methamm globin in urine which is allowed to stand. Fiut the. direct discharge of methminoglobin has been observed (Ehrlich). The blood-pigment is recognized by the spectroscope. The urine may show every shade from a pale reddish tint to a red Burgundy wine color. The urine is albuminous in proportion to the amount of ffirmoglobin. In the sedi ment the red blood corpuscles are either not found at all, or they are in such small numbers that they cannot explain the presence of the htraloglobin. The blood coloring matter is found frequently in the form of east, or amorphous masses, le, often in the form cf crystals. Hyaline and granular casts. and crystals of calcitun oxalate are seldom absent.
themoglobinuria results from a number of causes. In general it is the effect of a toxaunia, and this must be aceepted as the explanation even where we do not know the exact nature of the toxic proeess. The poisons which cause Iffemoglobinuria are well known,—the chlorine salts, phenol, naphtol, sulphuretted hydrogen, toluendiarnin, and also the mushroom poison, whieh has not yet been chemically determined. Passing over the very rare form of congenital htemoglobinurias: the Inemo globinurias resulting from the infeetious diseases (scarlatina, measles, typhoid fever, erysipelas, malaria), and the so-called paroxysmal Inemo globinuria are of especial interest to the pediatrist.* Among the infec tious diseases, aside from malaria, scarlet fever particularly predisposes to hwinoglobinuria. lieubner describes a case appearing upon the twentieth day of the illness with collapse, dyspnma, and great frequency of the pulse. He attributes the Inemoglobinuria to the action of the same toxins as are responsible for searlatinal nephritis.
The clinical aspect of paroxysmal hamloglohintiria merits a detailed description, since it appears occasionally in infancy. By this term is meant the appearance of htemoglobin or methtemoglobin in the urine in paroxysms. under certain conditions. The most important eause,
if not the only cause of this condition is cold. This anomaly is therefore a typical disease of eold.
Symptomatology.—Booner or later after exposure (cold bath or cold air) the child will complain of malaise, and of ehilly sensations. Typical shaking chills have been observed. The temperature may remain normal or it may rise above .10° C. JAM° F.). The child soon begins to complain of painful mieturition, the urine is of a more or less red color, resulting, from the presence of dissolved blood coloring matter. Other symptoms are due to vasomotor disturbance, pallor of the face, slig,ht cyanosis of the lips and ears, eold extremities. After a few hours the child begins to feel better as a rule, the quantity of haano g,lobin diminishes, and after three or four passages of bloody urine the normal quality may be restored. :‘Sometitnes the Inemoglobinuria is outlasted by a slight albuminuria. After severe paroxysms ieterus may appear and binary pigment as well as tirobilin and tirobilinogen may be excreted in the urine. Urobilinuria may be a symptom of abortive eases which do not progress to the escape of blood coloring matter.
Pathogenesis, great many theories have been advaneed to explain the appearance of hmmoglobinuria. They may be divided into two groups: the one supposes that the separation of the blood coloring. matter occurs ontside the general vascular s3,,stem; the other that it takes place within the vessels. Most of those who main tain the first theory consider that the kidney i8 the organ iti which the blood coloring matter is extracted from the strorna of thr blood cor puscles. The superabundance of blood in the kidneys which precedes the excretion of the coloring matter is said to be due to abnormal cir culatory conditions resulting from cold. Abnormal quality of the blood is said to be a predisposing factor. Another theory asserts that it is in the bladder alone that the coloring matter is extracted by a urine very rich in oxalic acid.