CHEMICAL PATHOLOGY 



1147 



the actual attack, but increased as it is passing off, and are con- 

 siderably increased in the intermission. Phosphoric acid is there- 

 fore retained in the body during the attack. 



As would be expected, iron is excreted in increased quantity, 

 probably due to haemozoin and haemosiderin, but this increase does 

 not really appear until after the actual attack is over, and then 

 continues for some days. 



As before remarked, the urine may contain a considerable quantity 

 of urobilin, and the indigo-blue may be also increased. 



Schlesinger's test for urobilin in the urine is performed by adding to the 

 unfiltered urine an equal quantity of a solution of 10 parts of zinc acetate 

 in absolute alcohol, shaking the mixture, and adding a few drops of a solution 

 of lugol, stirring and filtering, when a fluorescence will appear, varying in 

 intensity according to the quantity of urobilin present. 



The diazo-reaction is said to be obtainable in about 5-5 per cent, 

 of cases. Serum-albumen may be present after severe attacks, and 

 proteose has been reported, as well as nucleo-proteid. 



When the intermission comes, the urine diminishes in quantity, 

 but nitrogen is still excreted at a higher rate than it should be, 

 though less than during the attack. 



Chlorides are diminished, phosphates increased; sulphates, 

 though still higher than normal, are less than during the attack, 

 while the excretion of the bases is diminished. The excretion of 

 iron is marked, and the toxicity of the urine is said to be considerable. 



During convalescence the most marked features are the polyuria, 

 with low specific gravity, which in subtertian fevers may be so 

 marked as to alarm the patient, while in quartan and tertian it 

 may be so slight as to escape attention. There is also increase of 

 chlorides and potassium salts excreted. 



Urriola states that if the urine in malarial cases is centrifuged, four types of 

 pigment granules may be found: (i) very fine granules; (2) larger granules 

 in groups; (3) large masses; (4) granules in leucocytes and hyaline casts 

 It is, however, difficult to exclude extraneous matters. 



As regards the faeces, the most noticeable feature is the increase 

 in the excretion of bile and iron, both of which are related to the 

 blood-destruction. Ross and Thomson have shown that the quan- 

 tity of faecal urobilin (stercobilin) shows a marked correlationship 

 with the occurrence of the fever, being increased during the attack. 



The sweat of a malarial patient is well known to have a peculiar 

 odour, and contains substances very toxic to rabbits. 



The above chemical features point to the fact that the toxins of 

 malaria are excreted from the body by the sweat and the urine, and 

 that during the fever there is very active nitrogenous, potassic, 

 chloride, and sulphate metabolism. 



That there may be other toxins as yet unknown is obvious from 

 the fact that the Plasmodia cause marked shivering and a sensation 

 of coldness, even though the actual blood temperature is rising. It 

 would appear as though this is due to the constriction of the cuta- 

 neous vessels by some poison which acts on non-striped muscle. 



