786 PATHOGENIC PROTOZOA 



BLACK WATER FEVER 



This condition follows malaria and occurs only in malarial dis- 

 tricts, and by most authorities is believed to be a sequel of the disease, 

 due to some unknown factor. Castellani and Chalmers, however, 

 separate it into three forms, symptomatic, toxic and specific hemo- 

 globinuria, examples of which are, respectively, malarial and quinine, 

 hemoglobinuria and black water fever. In none of these, however, is 

 the etiology clear; the disease does not occur independently of ma- 

 laria, and an attack may be precipitated or aggravated by quinine. 

 Leishman has described certain cell inclusions, possibly chlamydozoa, 

 as the cause. The etiology is, at the present time, far from clear. 



TREATMENT OF MALARIA 



In quinine we have a true chemical specific for malaria, and when 

 given early enough and in sufficient doses, will cure the disease with 

 certainty. It is usually given in the form of the sulphate or dihydro- 

 chlorate, preferably in solution, but may be administered in freshly 

 prepared capsules; pills and tablets, while convenient, are unsatis- 

 factory because of their relative insolubility. It acts vigorously on 

 the merozoites and young trophozoites, but has almost no direct effect 

 upon the gametes. The size of the dose depends on the form of the 

 fever and its severity. In ordinary cases five grains three times a day 

 is sufficient, while in severe infections not less than thirty grains a day 

 must be given; the best time is immediately after meals, without re- 

 gard to the time of the chill. To prevent relapses, the treatment of the 

 original infection must be thorough, and the patient should be kept 

 in bed, upon a light diet and attention paid to the condition of the 

 bowels. During and after convalescence the treatment must be con- 

 tinued for three months, though the daily dose may be decreased 

 gradually, beginning a week or ten days after the subsidence of the 

 fever. In exceptional cases a relapse will occur while the patient is 

 still taking massive doses of quinine, and by some this has been looked 

 upon as an evidence of immunity of the parasite to the drug, but it is 

 possible that it is merely due to non-absorption of the quinine, and 

 carminatives should be added to the dose to assist in its absorption. 



OTHER MALARIAL PARASITES 



From time to time additional malarial parasites have been de- 

 scribed, only two of which are of any importance at present: Plas- 



