1214 



THE TROPICAL HEMOGLOBINURIAS 



Pathology. — ^As has been shown by de Blasi, Brem, and Zeiler, 

 the malarial parasites give rise to a haemoiysin which probably 

 varies in quantity and quality with different strains of parasites, 

 but is kept in check by the action of antihaemolysin, which is 

 formed in the body, but which under certain circumstances — e.g., 

 exposure to the weather, etc. — ^may fail to be produced in sufficient 

 quantities, and haemoglobinaemia with hsemoglobinuria may occur. 

 Brem found that three parts of a haemoiysin extract from a case of 

 pernicious malaria completely destroyed (hsemolyzed) one part of 

 a 5 per cent, suspension of erythrocytes in twenty minutes. This 

 haemoiysin is thermolabile. Zeiler and Brem have also demon- 

 strated the presence of antihaemolysin in the serum of normal indi- 

 viduals as well as in that of persons suffering from pernicious 

 malaria. It would therefore appear as though the presence or 

 absence of haemoglobin in an attack of pernicious malaria depends 

 upon the relationship between the quantity of haemoiysin produced, 

 and the amount of antihaemolysin also produced. 



Bijon considers that the resistance of the red corpuscles to lysin 

 is diminished, and Gasbarrini believes that the lysin lies inside the 

 red cells. 



Symptomatology. — ^The symptoms are those of an attack of per- 

 nicious malaria, in which the main feature is the presence of haemo- 

 globinuria, the other symptom,? being high fever, shivering, vomit- 

 ing, great prostration, and rapid anaemia. 



Diagnosis. — -The diagnosis is to be made by first demonstrating 

 the presence of L. malaricB in the blood, and then by the rarity of 

 severe jaundice. 



Treatment. — ^This is the same as for other forms of atypical sub- 

 tertian malaria (p. 1188) — ^viz., quinine in large doses, before which 

 calcium lactate in 5 to 10 grain doses may be given with advantage. 



Prophylaxis. — ^The prophylaxis is the same as for malaria. This 

 has been exemplified in Robertville, an Algerian village which was 

 highly malarious and where the malarial fevers were associated with 

 pyrexial haemoglobinuria. After 1910, when preventive measures 

 were instituted, according to Ciavaldini, the malaria decreased and 

 the hsemoglobinuria disappeared. 



2. QUININE H^ffiMOGLOBINURIA. 



Definition. — -An acute non-contagious fever caused by the ad- 

 ministration of any of the ordinary salts of quinine in certain cases 

 of malarial cachexia and chronic malaria, and characterized by 

 haemoglobinaemia and haemoglobinuria. 



Remarks. — Sir Patrick Manson has pointed out that an attack 

 of haemoglobinuria can be produced in certain cases by the ingestion 

 of a single small dose of quinine. Ross and Low have reported such 

 a case, under the care of Sir Patrick Manson, where the administra- 

 tion of a 9-grain dose of quinine was followed by haemoglobinuria 

 in a few hours. Ketchen has recorded a case of seven consecutive 



