PAROXYSMAL HIEMOGLOBINURIA Ilfemoglobinuria from cold; Psychogenic Htemoglobinuria.
In this affection there are paroxysmal secretions of dark blood colored urine, with or without ascertained causes. It should be dis tinguished from hfemoglobinu•ia of the newborn (Winckel's disease) and from symptomatic hcemoglobinuria which occurs after burns, poi soning with phosphorus, chlorate of potash, mushrooms, and has no paroxysmal character.
attack is usually preceded by a state of general irritability, lassitude, yawning; the attack itself sets in with chills, sensation of great cold, cyanosis, promptly followed by a state of heat and perspiration. Sometimes there is even collapse. Then there is a secretion of blood-colored urine, at first usually accompanied by severe pains. Frequently there are hyperemic spots appearing simultaneously on the skin, especially in parts affected by the cold, sometimes there are wheals. A few patients exhibit under certain circumstances gangrene at various parts of the body.
The urine is either blackish, dark red, burgundy or claret colored, but always dark colored. It contains abundant albumin, gives Heller's and Almen's blood test, but in the microscopic picture blood corpuscles arc absent. On the other hand, there are brownish, lumpy masses. In the spectrum it shows the bands of metlurmoglobin.
The blood in the first paroxysm shows the serum containing ha‘moglobin; there are also pale erythrocytes and so-called shadows (Burkhard). After the paroxysm both lurmoglobin and red blood corpuscles are diminished. The blood, however, recuperates very rapidly, so that on the following day the examination shows the blood already normal. During the interval between paroxysms there are
never traces of haemoglobin in the blood serum.
a predisposing factor there is at the bottom of many cases a previous chronic or acute infectious disease, especially hered itary syphilis, malaria, scarlet fever, and as immediate cause there is almost always a severe chill or thorough wetting; hence the appellation cold htemoglobinuria. Infectious factors do not appear to have any influence, this being probably a neurosis which chiefly affects the vasomotor system (von Recklinghausen).
Probably the chill causes primarily a change in the chemico-biolog ical composition of the plasma enabling it to exert a haemolytic influ ence upon the blood corpuscles. Especially suitable to the production of htemolysis is cold in conjunction with congestion. It is possible to produce by artificial experimentation hannoglobintemia and in specially predisposed persons also hxmoglobinuria, by cutting off the blood supply of a finger and after a while dipping the finger into cold water (Ehrlich's experiment), or by giving the patient a cold foot bath.
Course and Prognosis.—A single paroxysm generally lasts 11 to 2 hours. The paroxysms are repeated in irregular intervals according to the possibility of exposure to cold, and they are more frequent in winter than in summer. The prognosis depends upon the nature of the original trouble, but is on the whole favorable.