305 



3- On Presegmenting and Segmenting Forms. 

 These are, as we have said, rarely found in 

 the circulation, but if quinine is given at the 

 time that corresponds to tliis stage, the sub- 

 sequent effect is that very few young rings 

 appear ; at the next attack. 



QumiNE Haemoglobinuria 



Between this phenomenon and biackwater 

 fever there is, in . our opinion, practically no 

 difference. It is apparently true that cases of 

 biackwater fever do rarely occur in which no 

 quinine has been previously administered, and 

 in which we have the exciting cause of ' chill,' 

 other drugs, ' exertion,' etc., but it does not 

 effect the position that quinine, not necessarily 

 ,in large doses, is the common cause of this 

 phenomenon. We cannot here enter into the 

 evidence for this fact, but must refer to the 

 literature of the subject. 



Biackwater fever is then a quinine intoxi- 

 cation, but it is something more. It occurs 

 only in those who have previously suffered from 

 malaria, and, in fact, there is considerable 

 evidence to shew that it occurs frequently in 

 direct association with a malarial infection. It 

 has often been denied that biackwater fever is 

 nialarial at all, on account of the scarcity or 

 frequent absence of parasites, btit, as we shall 

 shew on page 308, this depends upon when the 

 examination is made. Regarding the haemo- 

 globinuria attack : — 



I. The haemoglobinuria follows the admini- 

 stration of quinine after a certain variable interval, 



V 



