containing  malarial  parasites.  On  one  occasion  (Case  2,  Table  46) 
it  happened  that  an  examination  of  the  blood  was  made  within  two 
hours  of  the  establishment  of  haemoglobinuria  and  one  hour  before 
the  administration  of  quinine.  In  this  case  no  parasites  could  be 
recognised  after  careful  search.  It  can  be  asserted,  therefore,  that  in 
this  case  haemoglobinuria  was  not  dependent  upon  the  haemolysis, 
in  the  peripheral  blood,  of  red  cells  containing  malarial  parasites. 
It  is  not,  however,  permissible  to  draw  a  general  conclusion,  applicable 
to  all  cases  of  blackwater  fever,  from  this  single  instance.  In  passing 
it  may  be  observed  that  the  assumption,  which  is  fre(|uenlly  encoun¬ 
tered  in  the  literature  of  blackwater  fever,  that  considerable  (that  is 
to  say,  up  to  20  per  cent,  or  more)  destruction  of  red  cells  occurs  in 
the  peripheral  blood  during  an  attack  of  blackwater  fever,  an 
assumption  based  upon  red  cell  counts  per  cubic  millimetre  made 
before  and  after  the  attack,  has  not  yet  been  established,  because 
the  total  volume  of  the  blood  has  not  been  determined  in  these  cases 
and  the  influence  of  any  accompanying  variation  in  the  volume  of 
blood  plasma  thereby  determined,  nor  has  the  high  degree  of  haemo- 
globinaemia  which  would  be  expected  to  result  from  such  extensive 
red  cell  destruction  been  met  with  in  our  observations.  It  may  be 
added  that  in  the  blood  films  referred  to  in  Table  46,  made  during 
and  immediately  before  haemoglobinuria,  the  red  cells  were  natural 
in  aspect,  no  partially  decolourised  cells  or  stromata  being  seen. 
If,  instead  of  the  peripheral  blood,  the  blood  in  internal  organs  is 
considered,  data  of  two  kinds  are  available,  the  one  relating  to  the 
enlargement  of  the  spleen  in  blackwater  fever,  the  other  relating  to 
the  presence  of  malarial  pigment  or,  less  frequently,  malarial  parasites 
in  the  blood  vessels  of  internal  organs.  Splenic  enlargement  is  a 
common  feature  in  attacks  of  blackwater  fever.  In  the  twenty  attacks 
coming  under  our  notice  the  condition  of  the  spleen  is  given  in  Table 
47.  riiis  organ  was  found  not  to  lie  ap|ireciably  enlarged  in  one 
case  (7)  in  which  the  attack  of  blackwater  fever  was  slight,  though 
two-  months  later  its  lower  border  projected  one  and  a  quarter  inches 
below  the  costal  margin  ;  in  four  attacks  the  condition  of  the  spleen 
was  not  recorded  (6a,  13,  14a,  15),  but  in  two  of  these  cases  it  was 
observed  to  be  enlarged  two  months  earlier  (6a,  14a);  in  the 
remaining  fifteen  attacks  the  spleen  was  enlarged,  slightly  in  four 
attacks  and  markcfllv,  that  is  to  say  projecting  one  to  four  inches 
