<30 TROPICAL MEDICINE AND HYGIENE 



froth is pink, and the spectroscope shows the haemo- 

 globin bands. Sometimes it is of a deep brown, 

 methaemoglobin in that case, and not haemoglobin, 

 being passed. 



The urine when passed is a valuable guide to the dura- 

 tion of the acute disease. If methaemoglobin alone is 

 passed the attack is only slight, but may be followed by a 

 more serious relapse. If much dilution is required to 

 render the urine transparent, a severe attack may be 

 anticipated. 



An examination of the second urine passed should be 

 made. If the first only be examined, confusion might 

 occur, as this is diluted by the urine that had previously 

 accumulated in the bladder. From the examination of 

 this second urine a fair estimate of the duration of the 

 haemoglobinuric period can usually be made. 



(3) After the onset of the haemoglobinuria urine is 

 secreted in much larger quantities than is normal, and 

 if abundant water be supplied either by the mouth, if 

 there be little or no vomiting, or by the rectum or subcu- 

 taneously, the rate of secretion continues high as long as 

 the haemoglobinuria lasts. 



The frequency of micturition at first is only increased 

 in proportion to the amount of urine secreted, the bladder 

 being emptied only when distended, but later the urine 

 is passed more frequently, and in small quantities only at 

 times, as the urine appears to act as an irritant to the 

 bladder. Occasionally there is marked irritability of the 

 bladder and penis, and in rare cases retention of urine. 



Jaundice, or rather a yellow staining of the skin and 

 conjunctivas, rapidly develops, and increases during the 

 continuance of the haemoglobinuria. There is no bile 

 in the urine, and the stools are very dark, so that the 

 jaundice is not obstructive, and is probably haemato- 

 genous. There is a marked increase in the amount of 

 urobilin in the faeces. This indicates that the products of 

 the blood destruction are discharged by the rectum as 

 well as with the urine. Constipation is usual, but is 



