240 



denied that blackwater fever is malarial at all, on 

 account of the scarcity or frequent absence of parasites, 

 but, as we shall show on page 243, this depends upon 

 when the examination is made. Regarding the 

 haemoglobinuria attack : 



1. The haemoglobinuria follows the adminis- 

 tration of quinine after a certain variable interval, 

 two to three frequently, five to six or possibly twenty- 

 four hours. 



2. The amount of quinine does not determine 

 whether the haemoglobinuria is slight or severe. 



3. After haemoglobinuria has been produced 

 by quinine, a second administration does not necessarily 

 produce a second attack of haemoglobinuria. 



These facts clearly shew that it is not the quinine, 

 per se, but a condition of blood in the particular 

 malarial patient which is the determining factor 

 whether quinine will produce an attack. 



This is further borne out by the well-known fact 

 that the aborigines rarely, if ever, suffer from haemo- 

 globinuria, but it is in Europeans subjected to unnatural 

 climatic conditions and subjected to virulent malaria 

 that the disease is most frequently found. 



We would only add, finally, that it is quite 

 illogical to abstain from quinine in malaria, on the 

 contrary, its adequate administration would prevent 

 the occurrence of these attacks. 



As we have already said, an accurate study of the 

 urine in these cases and in the allied cases of malaria 

 where quinine produces urobilinuria is necessary. 



Especially important is the study of the urine 

 and the blood in the prehaemoglobinuric state. It 

 would, of course,- involve an accurate study of all 

 possible subjects of the disease, and more especially 

 those who had already had an attack. 



