Malaria 99 



with the clump or clumps of pigment, in an irregular 

 heap ; its gamete, like that of the pigmented and un- 

 pigmented parasites of malignant quotidian infection, 

 is a crescent. The fever is irregular, rigour is not as 

 prominent ; pyrexia is more prolonged, often exceed- 

 ing twenty-four hours, and the incursive paroxysms 

 tend to overlap. 



Hemoglobinuris has symptoms, distinctive and 

 alarming, so that it should be regarded as having an 

 etiology distinct from that of ordinary malaria. Al- 

 though all known varieties of human malaria para- 

 sites have been found in the blood and organs of 

 hemoglobinures, such findings in a population so un- 

 usually affected with malaria as were the inhabitants 

 of the lowlands of Louisiana between Baton Rouge 

 and New Orleans, when these lands were practically 

 a rice field, do not establish a chronological relation 

 of a cause and effect, their presence being simply a 

 matter of coincidence. Nor is there any warrant for 

 the often repeated assertions that the present almost 

 complete exemption from this disease in this region 

 and the comparative freedom from all forms of ma- 

 laria are due to a more universal and a more liberal 

 use of quinine, for exactly the reverse is the case. 

 Then the vast majority of practitioners combated 

 both these ailments with enormous doses of this alka- 

 loid ; now most physicians terminate ordinary mala- 

 rial fevers with relatively small quantities of quinine, 

 and eschew its use entirely in the treatment of 

 hemoglobinurinic fever, believing its action harmful 

 rather than helpful ; in this opinion they are sus- 

 tained by high authority. 



