Those who defend the theory that the blood coloring matter is separated within the blood vessels, use a.-) an argument in their support the fact that hietnoglobin can be proved to be present during the parox ysms. Sotne believe that cold is the cause of the blood dissolution: others think it is due to toxic influences, either autointoxication, or infection by toxins from without. Ehrlich believes that under the induct), of cold there is produced a substance which will dissolve the blood corpuscles, and that this is autolysin. Chvostek suggested a mechanical destruction of the red blood corpuscles during the paroxystn. In the year 1904, Donath and Landsteiner succeeded by a series of ingenions experiments in advancing our understanding of the character of the alkali»). They made the following experiment: During the interval between the paroxysms of a haunoglobinurir patient, they took the blood, kept it liquid by oxalate of potassium, and preserved it for a, considerable time in a cold and in a warm state. Hremolysis did not appear. But when they cooled the oxalate blood and then placed it in the inenbator, the process WAS followed by haunolysis. I reviewed this experitnent, and proved it to be true. Therefore "the serum of a person with haanoglobinuria contains ft lytic substance which influences the human blood corpuscles. This ly.sin cannot be demonstrated when the luemoglobinuric serum is brought directly in rontact with its own corpuscles or those from another person, but it may be proved if »-e consider that its influence depends upon the temperature." Etiology.—As already stated the immediate cause is cold. Abnor mal blood conditions, of which the most important is hereditary syphilis, are predisposing causes. Stempel found syphilis 23 times among 77
carefully investignted eases; i.e., in 29.,: per cent. The same disease was found in DonatIds eases in id) per cent. In three cases of my nwn, I have proven hereditary syphilis with certainty in two. flow far other constitutional states are responsible for the appearance of paroxysmal hamoglobinuria we cannot definitely determine.
Course. The paroxysms as a rule last at I he ut most only a few hours. In the more serious eases they may he repeated every week, especially during the colder season, while warm weather generally leads to a temporary cure. There are individuals who respond to every exposure throughout their lives by a paroxysm of hntoglobinuria, but on the other hand cases have been described which recovered after puberty.
The prognosis so far as life is concerned is good. Where there is hereditary syphilis, an energetic course of mercury and the iodides may lead to recovery from paroxysmal ha-moglobinuria, at least in some cases. Of the complicating conditions which may lead to a fatal ter mination. nephritis holds the first place.
in importance from the standpoint of the etiology is vigorous antisyphilitic treatment, even in the cases where the syphilitic connection has not been definitely established. To break th,' paroxysm itself we have recourse to warmth, hot packs, and hot drinks.
Prophylaxis is naturally of the greatest importance. Individuals subject to paroxysmal ha-moglobinnria should be protected from chill ing, and, if their circumstances permit, they should spend the winter in a southern climate.