H^MOGLOBIN^MIA. AZOTEMIA. AZOTURIA. HE- 

 MOGLOBINURIA. TOXEMIA FROM IMPERFECT 

 HEPATIC FUNCTION. 



Definition. Theories, of hysteria, uraemia, spinal myelitis, myelo-renal 

 congestion, rheumatic lumbago, myosito-myelo-nephritis, rheumatic 

 chill with destruction of muscle albuminoids. Yet it occurs in our semi- 

 tropical midsummer with a temperature of 80 or 90, in spring and autumn, 

 and rarely even in the cold, damp stable in midwinter in the absence of 

 exercise. Constant conditions : One or more days absolute rest, preceding 

 steady work, a strongly nitrogenous ration, continued during the rest, 

 sudden active exertion accelerated breathing and unloading of peptones and 

 proteids from portal vein and liver into the general circulation. Sanguineous 

 albuminuria from excess of albuminous food, free ingestion of water, sup- 

 pressed milk secretion, forced marches. Transfusion of blood. Excess of 

 albumen dangerous, excess of red globules not dangerous. The blood con- 

 centration of diuresis or diaphoresis is not dangerous. Continuous muscle 

 decomposition from work bars the disease. Stable miasm untenable. Poison 

 may be drawn suddenly from the enormous mass of blood in the liver, 

 spleen and portal system. The absence of icterus antagonizes the bile 

 theory. Benzoic acid, unaltered peptones, and glycogen are examples of 

 elements destructive to blood. Normal destruction of red globules in liver, 

 spleen and bone marrow. Sudden access of resulting hsemoglobin to the 

 blood. Other products of disintegrated globules. Poisons from food, and 

 antitoxic action of liver in presence of glycogen. Carbon dioxide favors 

 solution of red globules. Theories of hsemoglobinsemia in man. Lesions : 

 Blood black, diffluent, irridescent, has no avidity for oxygen, with excess of 

 urea and extractives, serum of clot red, globules, small, pale, distorted, not 

 sticky, extravasations, liver, enlarged, congested, blood gorged, spleen con- 

 gested, swollen : Lumbar or gluteal. muscles pale, infiltrated, with loss of 

 striation ; bone marrow congested, hemorrhagic ; kidneys congested in- 

 farcted ; urine dark brown or red, with excess of urea and hemoglobin. 

 End of spinal cord has congestion or infiltration. Symptoms : History of 

 high condition, constant work, high feeding, a day's rest, then exercise and 

 attack. To full life, follows flagging, droops, moves one or both hind limbs 

 stiffly, knuckles, drags toes, crouches, trembles, perspires, breathes rapidly, 

 is tender on back, loins, croup or thigh, muscles firm, paretic, and drops 

 unable to rise. Urine retained, brown, red or black, sometimes glairy, 

 later may have casts. Appetite may return. In mild cases, stiffness, lame- 

 ness, with or without visible muscular lesions or tremors. Urine glairy, 

 dense, with excess of urea and nitrogenous products. Recover under care- 

 ful feeding and exercise, and relapse under original causes. Progress : May 

 recover under rest. In bad cases accelerated breathing and recumbency 

 forbid rest and recovery. Recovery in a few hours or after a week. Urinary 



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