Hemoglobinuria is the result of the destruction of the red blood-corpuscles, whereby the coloring matter is set free and eliminated by the kidneys, the coloring matter being found in the urine.
Etiology.—The destruction of these blood-cells is nearly always due to the presence of some toxin; either some one of the many toxic drugs, such as turpentine, carbolic acid, potassium chlorate, phosphorus, arseniuretted hydrogen; or of the infectious fevers, as typhoid, typhus, yellow fever, scarlet fever, diphtheria, malaria, syphilis, and all cachectic conditions, and those generated during metabolic changes. It may be due to the ingestion of certain fungi, as false mushrooms or tainted food of any kind, or from the ptomains developed in milk, cheese, canned goods, etc.
Paroxysmal Hemoglobinuria.—This form is very rare, and consists of the occasional passage of blood urine, in which only the coloring matter is present. While the cause is not known, it seems closely associated with the tendency to cold in sensitive people. It has also been associated with Raynaud's disease.
Pathology.—The pathology of the disease is unknown.
Symptoms.—The attack may come on suddenly, with chilly sensations, followed by febrile reaction, though in some cases the temperature may be subnormal. It generally follows exposure to cold, and is of short duration, usually subsiding within twenty-four or forty-eight hours. During the paroxysm, there may be vomiting and diarrhea, with pain in the lumbar region.
Diagnosis.—This can only be made by a microscopical and chemical examination of the urine. The urine has a red, brownish-red, or black color, and deposits a heavy sediment of the same color. The microscope reveals the absence of blood-corpuscles and the presence of granules or castlike formations, and sometimes crystals.
Prognosis.—It is generally favorable, though in malignant malarial hemoglobinuria fatal results may follow.
Treatment.—This will depend upon the causes giving rise to the disease. Rest in bed is necessary in all cases. Gallic acid, ergot, and the mineral acids should be tried. Erigeron and cinnamon must not be overlooked.