313 



Examination of the Urine in Blackwater 

 Fever 



1. Before the attack (if possible) examine 

 for albumen, urobilin, reducing bodies, etc. 



2. Examine so-called ' high-coloufed ' urines. 

 As a rule these do not shew bile pigment, 



3. Examine urine during an attack for 

 methaemoglobin (or haematin), oxyhaemoglobin, 

 urobilin, bile pigment (unusual), bilirubin crystals, 

 haemoglobin casts, granular or hyaline casts, 

 blood cells (rare). 



4. Centrifugalize the urine. Examine the 

 clear layer (as in 3), and make films of the 

 sediment. 



The sediment may contain hyaline and 

 granular casts stained with haemoglobin. The 

 mass of the sediment, however, consists of masses 

 of haemoglobin of a yellowish-red colour. 



Urobilinuria 



As we have indicated elsewhere, the occur- 

 rence of urobilin may be an important indication 

 in cases where a susceptibility to quinine 

 haeraoglobinuria exists : thus in Murri's case, a 

 girl had haemoglobinuria eight times between 

 August 3, 1894, and April 6, 1895, following 

 upon the administration eight times of small 

 doses of quinine. From 1895 to 1897, the girl 

 remained well. On March 27, 1897, she was 

 given o"5 grammes of quinine, to see whether 

 her disposition to quinine poisoning still re- 

 mained. The result was fever, vomiting of 

 bile, etc., albuminuria, peptonuria, and uro- 

 bilinuria (not haemoglobinuria). 



