MELAN.EMIA. 



typical occurrence of these brain-symptoms, as well as the occasionally 

 successful treatment of them by quinine, appears to me just as weighty 

 an argument against their dependence on obstruction of the cerebral 

 vessels by pigment. For it is impossible to see how the obstruction 

 should exist during the paroxysm and disappear during the apyrexia, 

 and there is just as little probability that the exhibition of quinine 

 could have a favorable effect on obstruction of the cerebral vessels. 



According to what has been said, with our present knowledge, we 

 can affirm nothing certainly of the connection between melanaemia and 

 the disturbance of the brain function. It is certainly possible that the 

 poisoning of the blood by marsh miasm, in malignant intermittent 

 fever, may excite other cerebral disturbances besides accumulation of 

 pigment in the cerebral vessels, and independently of that. 



In another series of cases, Planer and Frerichs found anomalies of 

 the renal functions in melanaemia. Occasionally the secretion of urine 

 was entirely arrested ; in other cases there was albuminuria ; in still 

 others, hasmaturia. The same objections urged against the dependence 

 of the brain-symptoms on obstruction of the cerebral vessels must be 

 equally valid against the dependence, at least the constant depend- 

 ence, of functional disturbance of the kidneys on obstruction of the 

 renal vessels. Among others, Frerichs saw albuminuria occur with- 

 out pigmentation of the kidneys ; and, on the other hand, albuminuria 

 was absent in five cases where there was pigment in the kidneys. 

 But, if there was albuminuria, this observer found that the amount 

 of albumen in the urine was decidedly increased during the paroxysm, 

 and decreased or disappeared during the interval. From analogy with 

 other miasmatic affections, it certainly cannot be denied that the infec- 

 tion of the blood with marsh miasm may disturb the nutrition and 

 functions of the kidneys, even without obstruction of the vessels. 



Lastly, in melanaemia Frerichs observed exhausting intestinal 

 haemorrhage, profuse diarrhoea, acute serous effusions into the peritoneal 

 sac, and bloody suffusion of the serous coat of the intestines. It ap- 

 pears improper to refer this symptom also to obstruction of the ves 

 sels of the liver, and to congestion in the roots of the portal veins 

 for, although in all the cases observed by Frerichs, next to the spleen, 

 the liver appeared to contain the most pigment, the symptoms that 

 apparently indicated disturbance of the circulation in the roots of the 

 portal veins were not by any means constant, and were not nearly so 

 frequent as the cerebral symptoms. Moreover, the intestinal haemor 

 rhages observed by Frerichs in three cases had distinct intermissions ; 

 and, while they resisted treatment directed against the haemorrhage di- 

 rectly, they yielded to large doses of quinine. Frerichs even refers 

 the fatal result in one of these three cases to neglect in the adminis- 



