174 
On Hemoglobin Metabolism in Malarial Fever. (Preliminary 
Note.) 
By G. C. E. Simpson, B.A., B.Se., F.R.C.S. 
(Communicated by Major R. Ross, F.R.S. Received October 12,—Read 
December 8, 1910.) 
The object of this study was to examine some of the cases of malaria 
reported upon by Major R. Ross and Dr. David Thomson in their paper on 
“Enumerative Studies on Malarial Fever,’ with especial reference to the 
meaning ‘of the fall of hemoglobin there recorded during pyrexia, in the 
ultimate hope that some light may thus be thrown on various problems 
connected with malaria, and especially with blackwater fever. 
The chief product of hemoglobin metabolism, and the only one available 
for quantitative work, is the urobilin which is removed from the body partly 
in the urine, partly in the feces. Previous observers have devoted much 
attention to the quantitative determination of urinary urobilin in health 
and disease, and have shown that it is increased in diseases connected. with 
pyrexia and with hemolysis. In benign tertian malaria the urinary urobilin 
is excreted in quantities comparable to those in other diseases. In malignant 
tertian malaria the excretion of urobilin in the urine is somewhat higher. 
Occasionally very marked urobilinuria occurs. 
The main channel of elimination of urobilin, however, is the feeces, and this 
fact has been somewhat neglected in comparison with the urinary estimations. 
Serious difficulties are met with owing to variations in composition of fecal 
urobilin. The amount of urobilin in the feces nearly always completely 
overshadows that in the urine. In our cases of benign tertian malaria, the 
excretion of fsecal urobilin is again found to be comparable to that in other 
pyrexial diseases. In malignant tertian malaria, however, a high output is 
the rule, and occasionally a very large output occurs. This is of importance 
as showing that great hemolysis has occurred and that an amount of hemo- 
globin (25 per cent.) has been destroyed (and its products excreted) com- 
parable to the fall recorded by the hemoglobinometer; this shows that the 
hemoglobinometer readings denote an actual destruction of corpuscles, and 
not merely a relative fall in the peripheral circulation. _ The number of 
corpuscles destroyed is much larger than the number infected by parasites. 
The eliminating organs deal with a large amount of hemoglobin during 
the pyrexial periods and the days which immediately follow; this would 
seem to indicate a continual loading of the blood plasma with freed hemo- 
