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September 16, 1974

A Different Drummer

JAMA. 1974;229(12):1639. doi:10.1001/jama.1974.03230500057032

Hemoglobinuria, occurring—albeit infrequently—after a long march or run, was originally attributed to exertion and thus labeled "exertional." Later, when it was observed that the exertion always entailed prolonged locomotion, this syndrome was renamed "march hemoglobinuria." Only after Davidson1 had provided convincing evidence that trauma to the capillary bed of the soles was responsible for the fragmentation of erythrocytes, did the traumatic nature of this pigmenturia become apparent.

The traumatic etiology became even more obvious when Streeton2 reported a variant of "march" hemoglobinuria occurring not after marching, but after karate exercises. The trauma was brought about not by the impact of the sole but by that of the fist and ulnar aspect of the hand on concrete and wooden surfaces. Just as in the case of the stomping marcher, it could be prevented by the interposition of foam rubber at the areas of impact.

Another variant of "traumatic"—the term