Diseases of the kidneys and of the spleen, hemorrhagic diseases / by H. Senator and M. Litten ; edited, with additions by James B. Herrick ; authorized translation from the German, under the editorial supervison of Alfred Stengel.

  • Hermann Senator
Date:
1905
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the kidneys and of the spleen, hemorrhagic diseases / by H. Senator and M. Litten ; edited, with additions by James B. Herrick ; authorized translation from the German, under the editorial supervison of Alfred Stengel. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    blood-cells. His discovery was followed by a series of communications, chiefly by English physicians (G. Harley/ Dickinson,^ W. Gull/ Has- sal/ Pavy/ and others), under the caption of intermittent or winter hematuria or hematinuria, and later by Lichtheim,^ Kobert, Kiissner,^ and many others in Germany, so that we now have a fairly extensive literature on this disease. The attacks are frequently ushered in by a chill which is followed by fever, the temperature at times rising to 40° C. (104° F.) and over. [At the time of the chill the temperature may be low. Saundby^ cites a case in which the axillary temperature was at first only 96.1° F. —Ed.] The fever is accompanied by dragging pains in the back, run- ning down into the thigh, pallor of the skin, and later cyanotic discol- oration of the finger-tips, toes, and ears. [In a case reported by Rohrer ^ bluish or violet discoloration of the ear was followed by super- ficial gangrene. Somewhat similar gangrenous effects have been seen by Hilton Fagge and Pye-Smitn. In some instances Raynaud's disease has been associated with paroxysmal hemoglobinuria.—Ed.] Lassi- tude, a tendency to yawning, oppression, nausea, pains in the hypochon- driac regions, and occasionally neuralgic pains in the extremities, have also been observed. In some cases there is a slight icteroid discoloration of the skin and mucous membranes or a macular hyperemia with urti- carial ivheals. [Circumscribed edema is sometimes seen, and rarely pur- puric lesions.—Ed.] Parques ^^ had a patient in whom urticaria could be produced by cooling the hands; the wheals were of a peculiar red color and lasted from one to two hours. The fever is followed by sweat and subsidence of all the subjective symptoms. The urine evacuated during the attack appears bloody or dark red- dish-brown. On spectroscopic examination it shows the presence of methemoglobin, either alone or in association with hemoglobin (see Hematuria, p. 51); and on microscopic examination amorphous blood- pigment in granules or irregular masses or in the form of casts or, occa- sionally, in crystalline form is usually found, but no red blood-cells or very few. In addition the sediment often contains hyaline and granular casts, renal epithelial cells whose nuclei are also stained red, and not infrequently calcium oxalate in unusual abundance. The uriue always contains albumin and often bile pigment; but, according to Leube,^^ bile acids are absent. In one instance the latter found a diastatic ferment in the urine. As the attack subsides the color of the urine becomes paler and paler, until finally it is impossible to demonstrate any blood- pigment ; the albumin, however, does not disappear until after a few ^ Med.-Chi. Trans., 1865, xlviii., p. 161. ^ Med.-CU. Trans., 1865, xlviii., p. 175, * Guy^s Hos-p. Reports, 1866, xii. * Lancet, 1865, i., p. 368. * Cruy's Hosp. Reports, xviii., and Lancet, 1868, ii., p. 33. ^ Volkmann's Sammlung Min. Vortrdge, 1878, No. 134. ' Berlin, klin. Woch., 1878, No. 43, and Deutsche, med. WocL, 1879, No. 37. ^ Renal and Urinary Diseases, p. 418, Philada., 1897. ^ Ueber ein Symptom der Hamoglobinurie: Cyanose und Grangran am Ausseren Ohre, Zeitschr.f. Ohrenheilk., xxxix., 2. ^Semaine med., May, 1898. ^^ Wurzburger physikaL-med. Sitzungsber., 1886.
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