SPOROZOA 1129 



and specific hemoglobinuria, 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 malaria, 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. Malarial parasites may be present 

 in the blood up to time of the appearance of the hemaglobinuria, 

 but then they rapidly disappear since it is the infected parasites 

 which first undergo destruction. To determine the presence of 

 hemaglobin with certainty the urine should be examined with a 

 spectroscope; small models are made which are suitable. The 

 hemaglobin in the blood falls rapidly, to twenty-five per cent or 

 even less ; the number of red cells is also diminished, often to three 

 million per cubic millimeter or and in severe cases to a much lower 

 figure. 



In these cases quinine must be stopped until the hemaglobinuric 

 attack is over, when the parasites reappear and the malaria must 

 again be treated. In the mean time the patient should be kept in 

 bed and be given the best possible care and nursing. 



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 regard 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 continued for three months, though the daily 



