H^MOGLOBINURIC FEVER 385 



thelial cells of the blood capillaries, stimulating them to excessive 

 destruction of red blood cells by phagocytosis. 

 (2) This phagocytosis results in the production of an auto- 



Diagrammatic representation of the condition of the kidney in health (A), during 

 experimental hemoglobinuria of rabbit (B), and in suppression of urine following upon 

 blackwater fever (C). In B small casts are present in some of the uriniferous and 

 collecting tubules ; in C large casts are present in many of the uriniferous and collecting 

 tubules. In the latter, considerable enlargement of the kidney is also observed. For the 

 sake of comparison B is represented as tri-papillary instead of being uni-papillary, as in the 

 rabbit. — (From the " Annals of Tropical Medicine and Hygiene," Liverpool University, 

 by permission.) 



h^emolysin retained in the endothelial cells until set free by some 

 exciting cause as chill, over-exertion, &c. 



(3) The hc'emolysin is then suddenly set free and destroys the red 

 cells by solution in the plasma, principally in the blood of the 

 liver, kidney and spleen. 



(4) This lysiemia produces h^emoglobinaemia, quickly appearing in 

 the urine as oxyh^emoglobin, which may become meth- 

 haemoglobin on standing. 



(5) Some of it, the liver probably converts into bile; the remainder 

 passes out in the urine. 



(6) Large coarsely granular casts in the ducts of Bertini mechani- 

 cally block the tubules and cause suppression of urine (Barrett). 



