240 
denied that blackwater fever is malarial at all, on 
account of the scarcity or frequent absence of parasites, 
but, as we shall show on page 243, this depends upon 
when the examination is made. Regarding the 
haemoglobinuria attack :— 
1. The haemoglobinuria follows the adminis¬ 
tration of quinine after a certain variable interval, 
two to three frequently, five to six or possibly twenty- 
four hours. 
2. The amount of quinine does not determine 
whether the haemoglobinuria is slight or severe. 
3. After haemoglobinuria has been produced 
by quinine, a second administration does not necessarily 
produce a second attack of haemoglobinuria. 
These facts clearly shew that it is not the quinine, 
q>er se , but a condition of blood in the particular 
malarial patient which is the determining 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 haemo¬ 
globinuria, 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 the 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. 
