CHAPTER XLI 



THE TROPICAL HEMOGLOBINURIAS 



General remarks — Malarial hsemoglobinuria- — Quinine hsemoglobinuria — 

 Blackwater fever^ — References. 



GENERAL REMARKS. 



HEMOGLOBINURIA or the presence of more or less altered haemo- 

 globin in the urine, is found in a number of conditions which may 

 be approximately classified into: — 



1. The Symptomatic HaBmoglobinurias, which occasionally occur 

 in the course of such diseases as malaria, Raynaud's disease, the 

 acute specific fevers, and after severe burns. 



2. The Toxic Haemoglobinurias, which are brought about by the 

 action of a number of drugs, as, for example, quinine and its salts, 

 chlorate of potash, antipyrin, carbolic acid, and naphthol, and by 

 certain vegetables used as food, as, for example, certain beans 

 (Favism, w^?^ p. 201). 



3. The Specij&c Haemoglobinurias, which are specific diseases, such 

 as blackwater fever and paroxysmal hsemoglobinuria. 



In the tropics we are concerned with one entity in each of these 

 groups — ^viz. : — 



1. Malarial haemoglobinuria. 



2. Quinine haemoglobinuria. 



3. Specific blackwater fever. 



1. MALARIAL HSEMOGLOBINURIA. 



Definition. — Malarial haemoglobinuria is simf)ly a haemoglobinuria 

 caused by Laverania malaricd Grassi and Feletti, 1890. 



History. — ^This form of haemoglobinuria has been much confused 

 with quinine haemoglobinuria and with blackwater fever. It is 

 simply a haemoglobinuria occurring in the course of atypical sub- 

 tertian malaria, and caused by the malarial parasites. Stephens 

 has seen it associated with quartan parasites. 



etiology. — ^The aetiological factor is L. malarice Grassi and Fel- 

 letti 1890, together with some other factor, which inhibits the 

 production of antihaemolysins. 



Climatology. — -The distribution is coextensive with the distribu- 

 tion of the more severe forms of malaria, and is therefore most 

 evident in the tropics and subtropics. 



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