Selected Monographs.

  • New Sydenham Society
Date:
1888
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Licence: Public Domain Mark

Credit: Selected Monographs. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    noted as being present in the urine, there is no record of haemo- globin. In Dr. Southey's second case* of local asphyxia and symme- trical gangrene, there was for several days a true intermittent haematuria, provoked apparently by impressions of external cold to the surface of his body. It is noted that the blood was usually very apparent by its dark colour, and the obvious sediment it gave, but its 'presence was at times only detectible by the guaiacum reaction. Oxalates either preceded or accompanied the haema- turia usually. It seems probable that this case was at times, at all events, one of haemoglobinuria. In one of the cases recorded by the translator, f the onset was marked by epigastric pain, and hemoglobinuria was observed to occur within one or two hours from the beginning of the local asphyxia of the limbs. The dark urine only appeared once after a given attack. It gave the reaction with guaiacum, and presented under the microscope pigment and oxalates, but no blood cor- puscles. The urine gave the spectrum characteristic of met- haeinoglobin. The translator pointed out the marked parallelism between typical cases of intermittent haemoglobinuria and cases of Raynaud's disease, strictly so called, in which the paroxysmal character of the local asphyxia must be considered an essential note of the morbid phenomena. They are not in a true sense periodic, but they are both paroxysmal. Attacks in both affections have a remarkable relation to changes of temperature. By far the greater number of cases of both are exclusively winter or cold weather affections, and if not exclusively they are primarily so, and if the attacks do not vanish, they notably diminish when the warm weather appears. In both, the paroxysms may begin with yawning or with vomiting, and the extremities, as I can testify, may in the onset of an attack of paroxysmal haemoglobinuria become extremely cold and blue. In both, the attacks may be accompanied by some abdominal pain, and both may be followed next day by sleepiness and by a certain sallowness of complexion and of conjunctivae. It is the rarest event for an attack of intermittent haemoglobinuria to occur when the patient is in bed, and this exemption also * Trans. Clin. Soc, xvi., 1883, p. 167. f Dr. Barlow, three cases of Raynaud's disease. Trans. Clinical Society, xvi., 1883, p. 179. Also sequel to above. Trans. Clinical Society, xviii., 1885, p. 307.
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