A report on hemoglobinuric fever in the Canal Zone : a study of its etiology and treatment / by W.E. Deeks and W.M. James.

  • Deeks, W.E.
Date:
1911
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Licence: In copyright

Credit: A report on hemoglobinuric fever in the Canal Zone : a study of its etiology and treatment / by W.E. Deeks and W.M. James. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    cases in which an examination of the blood is made; the relation be- tween the intensity of the infection and the gravity of the symptom is usually quite evident. Hemoglobinuria, on the other hand, is a phenomenon which may be manifested during the course of an active infection as well as in one which has spent its course; it is intimately related to malaria, but there is no direct casual relation between this phenomenon and the malarial parasites, such as there is, for example, between the coma of a pernicious attack and the parasitic invasion of the capillary vessels of the brain. Nor do we believe that we can class together, as some have done, hemorrhagic malarial infections in general and hemoglobinuria. Indeed, cutaneous or mucous-membrane hemorrhage (nasal, intestinal, and the like) constitutes a symptom which may accompany grave malarial infections, while hemoglobinuria may develop in malarial subjects under the most varied conditions, as will appear in the course of our study. We may also add that, while the pathogenesis of the pernicious attacks has been in great measure cleared up by the recent parasitological investigations, the same cannot be said of hemoglobinuria, the pathogenesis of which is still not only obscure, but is also certainly more complex. We have included in our analysis only those cases that in our opinion manifested the characteristic blackwater due to hemoglobinuria, with the presence of the granular detritus and the hemoglobin casts peculiar to the disease when a microscopical examination of the urine was made. The onset of the blackwater is sudden and paroxysmal, and almost always is associated with a chill and more or less severe constitutional disturbances, such as fever, vomiting, abdominal distress, liver pains, and the appearance of jaundice more or less severe. The resulting anemia depends upon the amount of blood destruction, and the prognosis upon the severity of the above-mentioned symptoms in conjunction with the kidney lesions. These latter vary from slight irritation to almost complete destruction of the epithelial tissues, thus leading to suppression. This condition, which almost always is fatal, will be referred to later. A close relationship between malaria and hemoglobinuric fever has long been suspected, but whether that relationship is etiological or accidental has been a mooted point. The researches of Christophers and Bentley^ into this problem have gone far toward establishing very strong presumptive evidence in favor of malaria as the necessary pre- disposing cause of hemoglobinuric fever. These writers, however, admit that every consideration must be given to the hypothesis of the specificity of some hitherto undiscovered organism.