3o6 



two to three frequently, five to six or possibly 

 twenty-four hours. 



2. The amount of quinine does not deter- 

 mine whether the haemoglobinuria is sHght or 

 severe. 



3. After haemoglobinuria has been produced 

 by quinine, a second administration does not 

 necessarily produce a second attack of haemo-' 

 globinuria. 



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 determin- 

 ing 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 

 haemoglobinuria, 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 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. 



