H^MOGLOBINURIC FEVER 383 



(5) That it is a Condition brought about by a previous Malarial 

 Infection. 



A case of h^emoglobinuria usually gives a history of one or more 

 attacks of malaria. Small doses of cjuinine in some such Central 

 African patients is sufficient to precipitate the disease (Sandwith). 



The subtertian parasite seems to be usually the parasite of the 

 malaria. This accounts for the statement that malaria (benign tertian 

 or cjuartan) may be prevalent, but no h^emoglobinuria. 



The Ancon Hospital Records show that malaria complicates prac- 

 tically every other disease, but neither clinically nor at autopsy has 

 blackwater fever complicated any infectious disease other than malaria. 

 In not one case of blackwater can evidence of malaria, either remote 

 or immediately prior, be excluded (Decks and James). 



The hiemoglobinuria seems to be a h^emolytic toxic action. 



Subtertian malaria has a strong toxic action, as evidenced by the 

 cytolytic action upon the kidney cells and the parenchymatous focal 

 neurosis of other viscera. Haemolysis is closely allied to cytolysis, in 

 the former case the cells of choice being the erythrocytes. 25 per cent, 

 of the red cells may be destroyed as a result of one paroxysm of sub- 

 tertian malaria. Although the life of a red cell is perhaps only four 

 weeks and the whole is regenerated every twenty-eight days, the 

 vascular system could not long stand the strain. 



The writer had a case that gave 850,000 red cells per cubic millimetre 

 the second day of the fever. 



In studying 230 cases of hcemoglobinuric fever at Ancon Hospital, 

 Decks and James write their views thus : — 



An haemolysis has two groups, a combining and a destructive 

 group. The first must unite with the cell before the latter can destroy 

 it. The exciting factors are : — 



(i) Renewed malarial paroxysms to produce sufficient toxin to 

 overwhelm the cells. 



(2) Then a lowering of body resistance. 



(3) The adiliinistration of ciuinine which may act in either of two 

 ways : — 



By depressing the vital processes of the bodv, or 

 By acting as the toxophore radical of the h^emolvsis. 

 No regularity of results following the administration of ciuinine 

 can be predicted. H^emoglobinuria has followed the taking of i grain 

 of quinine, in others it has not resulted after taking 30 grains over 

 several days, but it does not occur except in tliose who have had a 

 previous attack of malaria. 



Forty-two thousand cases admitted for diseases other than malaria 

 did not develop one single case of blackwater. 94-6 per cent. (246) of 



