Definition:—This disorder is one in which from previous disease, or from the taking of poisons or from other cause, there is a dissolution of the red corpuscles of the blood, the pigments of which, especially the hemoglobin, being eliminated through the kidneys in the urine. There are no blood cells in the urine, as in hematuria, but disseminated blood coloring matter only.
Etiology:—The condition most commonly results from the direct influence of poisons, such as carbonic acid gas, naphtha and other petroleum vapors, or from phosphorus, arseniuretted hydrogen, potassium chlorate, pyrogallic acid and turpentine, and from poisonous mushrooms. I have frequently called the attention of my students to the influence! of the coal tar synthetic remedies, when used persistently, in inducing corpuscular changes in the blood which result in the formation of methemoglobin. The anemia which follows the protracted use of these remedies is attributed to the disease, and observation is not always made to determine the number of red blood corpuscles or the presence of the pigments in the urine. Hemoglobinuria also follows the infectious fevers, very commonly malarial fever and other cachectic conditions, and severe burns. It is induced by the toxins of decomposing food, and those found in canned meats and canned fruits, cheese, old milk and icecream.
The condition occurs also in a form known as paroxysmal hemoglobinuria, when without apparent cause persons in previous good health will pass quantities of hemoglobin and other blood pigments in the urine for a short period. This is variously attributed to the results of exposure to cold or violent physical exertion, or to the presence of syphilis, or as a warning of the approach of Renaud's disease. Hare relates a case of one of his patients who brought on repeated attacks of hemoglobinuria from the inhalation of the vapor of gasoline from his automobile.
Symptomatology:—The symptoms are those of the condition which induces it. Those symptoms which are common to most cases are malaise or slight chill and mild fever, aching or pain in the loins, slight nausea or vomiting with anorexia, and perhaps diarrhea.
The urine may be slightly increased in quantity, is passed at more frequent intervals, and may induce pain in the passing. In mild cases the color is dark reddish-brown, and clear, with but little if any sediment on standing, until decomposition of the urine occurs. In others there is turbidity with the same deep reddish-brown or smoky color, inclining to black, and there is an immediate deposit of some amount of sediment, which later becomes heavy and is quite black in color, unless mixed with pus, when present with pyuria.
Diagnosis:—The appearance of the urine is suggestive, but not positive. The urine is acid in reaction, and but few if any corpuscles appear under the miscroscope. Small brownish flakes of disintegrated hemoglobin are found. In the blood examination there is a reduction of the red corpuscles and the serum is slightly discolored.
Treatment:—The conditions which act as the cause of hemoglobinuria must all be carefully and persistently treated according to the indications. All causes should be removed and any poisons yet within the system should be antidoted. The patient should be put to bed and external warmth applied. If fever is present, it must not be overlooked. Free action of the skin should be induced and the kidneys may be slightly stimulated.
The use of the astringents named under hematuria is indicated, but similar marked results will not be apparent. In the final restoration of the patients those tonics should be given, with carefully selected food, which are calculated to restore the original integrity of the blood.