Notes on a case of paroxysmal methaemoglobinuria / by A. Lockhart Gillespie.

Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Notes on a case of paroxysmal methaemoglobinuria / by A. Lockhart Gillespie. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    corpuscles, 3,530,000, size G to 9 /x; some tailed, not so irregular as yesterday. White corpuscles, 15,000. Plates as usual. Haemo- globin, 66 per cent., or per corpuscle 934 per cent. The spleen, if anything, is smaller than yesterday. 15th December.—Yesterday the day was colder, and although only out about three hours he felt very cold; he did not shiver, however. Temperature up; urine dark red. Blood analysis: Red corpuscles, 2,980,000, of various sizes, from 5 to 9 /x; none tailed or vacuolated, but one or two very shadowy. White corpuscles, 20,000. Plates numerous. Haemoglobin, 64 per cent., or 107’3 per cent. Urine the colour of port wine, clear, no deposit; sp. gr., 1031; no sugar; acidity, T62 per cent-., or ’08748 gram, per diem ; urea, 9’524 grs. per oz., or 514’296 grs. altogether. The pigments present in the urine were oxyhaemoglobin and a trace of methaemoglobin, the lines distinctive of the latter only being visible in a thick layer of the fluid. The proteids present were '6 per cent., of which serum albumen formed -25 per cent., the globulin ‘35 per cent. His spleen had again enlarged, but was not tender. On the 16th the haemoglobin had risen to 70 per cent., the red corpuscles to 3,850,000, or 90’9 per cent, per corpuscle. One or two phantom corpuscles, while the red cells as a rule were smaller but more regular, 4 to 6/x in size, forming fairly good rouleaux. Urine: pale, deposit of mucus; sp. gr., 1025 ; urea, 232 96 grs. in the day; acid, ’03024 gram. No albumen or blood. Seeing that his blood was in such an unstable condition, I resolved to try the effect of sulphonal on it, so I gave him 20 grs. on the night of the 16th. On the 17th his blood contained 2,930,000 red corpuscles, many of which were phantom ; size, 5 to 8 /ul ; none crenated, many elongated. Haemoglobin, 70 per cent., or 119 per cent, per corpuscle. Urine contained no albumen or uro-haemato-porphyrin, and was normal. I gave him 30 grs. of sulphonal that night again, with no dis- coloration in the urine, and 35 grs. on the following night, with a similar want of success. He now expressed a desire to go home, so that I had to stop my observations. On dismissal he felt and looked very much better. Conclusions. The points I would particularly draw attention to are—first, the enlargement of the spleen with each attack; second, the fact that the percentage of luemoglobin did not fall pari passu with the corpuscles; third, that the total urea excreted during the day increased on the day of the attack, contrary to what is otherwise affirmed (Miinchener Medicinischer Wochensclirift, 1888, xxxv., pp. 495, 529, and 535). The proteids, too, merit attention, as does the temperature. The size of the corpuscles, also, varies after the attacks.
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