QUININE HEMOGLOBINURIA 



1215 



hsemoglobinurias in the same individuaHn whom each attack was 

 the sequel to a dose of quinine. We have met with similar cases, 

 but our maximum is six attacks in one year. 



History. — ^Veratas in Greece, in 1858, was the first to draw atten- 

 tion to this form of fever, and to definitely ascribe the haemoglobin- 

 uria to quinine, and he was followed and supported by Tomaselli, 

 GroGco, and many other Italian and Grecian observers. Later 

 Plehn, Koch, and others, have strongly advocated this theory, but 

 these last observers have applied this one hypothesis for the ex- 

 planation of all the conditions included under the term ' blackwater 

 fever.' 



Climatology. — ^The attack can take place an5rwhere for the first 

 time, provided that the individual is suffering from chronic malaria, 

 etc., and the unknown factor or factors to be mentioned below, and 

 has taken the requisite dose of quinine. 



etiology. — ^The causation of this condition is the administration 

 of quinine in cases of malarial cachexia and chronic malaria, but 

 this is not the entire 3etiology, otherwise the condition would be 

 more commonly met with than at present, and also it is quite safe 

 to administer quinine to the majority of cases of chronic malaria 

 and malarial cachexia without causing haemoglobinuria. More- 

 over, the administration of a dose of a salt of calcium prior to the 

 quinine will prevent the haemoglobinuria, which in the same indi- 

 vidual has occurred after such administration. 



From one observation which we have made we would throw out the sugges- 

 tion that one of the other factors in quinine haemoglobinuria may be the 

 condition of the kidney, and that the site of the haemolysis may be in that 

 organ. 



Pathology. — ^The pathology of quinine haemoglobinuria is but 

 little understood, but it has been very ably studied by Barratt and 

 Yorke, who demonstrated the action of quinine in alkaloidal form, 

 and as the bihydrochloride as well as hydrochloric acid and sodium 

 hydrate upon healthy red blood cells, and found that : — 



1. All the above-mentioned agents produced haemolysis. 



2. In equimolecular concentration the haemolytic power is nearly 

 the same. 



3. The haemolysis produced by quinine (alkaloid) resembled a 

 catalytic action, and took place at a monomolecular rate. 



4. During life it is not possible to reach a percentage of quinine 

 in the blood sufficient to cause haemolysis, owing to the toxicity of 

 the drug. 



With regard to the action of the quinine, some observers believe 

 that it produces the haemolysis by lowering the osmotic pressure of 

 the blood plasma. 



Morbid Anatomy.— We are not acquainted with any direct 

 observations on this subject, but the appearance of the kidney in 

 people who have died from pernicious malarial fever in which large 

 doses of quinine have been administered without success resembles 



