glomerulus  but  by  the  epithelium  of  the  renal  tubule,  it  is  possible  that 
this  epithelium  may  necessarily  contain  during  haemoglobinuria  brown 
granules  of  hacmogdobin  as  observed  by  A^archiafava  and  Bignamr 
(cp.  also  Alarchandt  and  AfanassiewJ).  This  is,  however,  on  the  whole, 
improbable  ;  such  an  appearance  seems  to  have  been  rarely  met  with, 
and  was  not  observed  in  our  experimental  cases.  In  all  probability 
the  presence  of  granular  material  in  the  lumen  of  the  renal  tubules 
is  the  sole  change  recognisable  to  the  naked  eye,  which  the  kidney 
presents  during  haemoglobinuria.  As  regards  the  degenerative 
changes  occasionally  observed  in  the  renal  epithelium  after  death, 
the  circumstance  that  the  urine  ordinarily  becomes  quite  normal  after 
the  attack  of  blackwater  has  ended,  no  trace  of  coagulable  proteid 
remaining  in  the  urine  after  haemoglobin  has  disappeared,  shows  that 
as  far  as  mere  haemoglobinuria  is  concerned  the  renal  epithelium  is 
unaffected,  the  elimination  of  haemoglobin  being  effected  by  healthy 
epithelium  as  occurs  in  the  rabbit  during  e.xperimental  haeino- 
globinuria  (Figs.  44-51  and  59-bo).  No  parenchymatous  change  of  the 
epithelium  necessarily  attends  the  appearance  of  haemoglobinuria, 
nor  does  the  constitutional  disturbance  accompanying  blackwater 
fever  seem  to  be  usually  accompanied  wuth  any  secondary  affection 
of  the  renal  epithelium.  Whether  the  granular  material  in  the  renal 
tubules  ordinarily  causes  some  obstruction  to  the  flow  of  urine  is 
uncertain.  No  diminution,  but  an  increased  flow  occurred  in  the 
experiments  on  rabbits  detailed  in  Table  35.  In  blackwater  fever 
patients,  however,  a  diminished  flow  of  urine  may  be  observed  not 
unfreqiiently  during  haemoglobinuria  (cp.  p.  134),  The  circumstance 
that  interstitial  changes  are  usually  absent  after  death  from  black¬ 
water  fever  may  be  regarded  as  negativing  the  necessary  association 
of  this  condition  with  the  production  of  haemoglobinuria. 
We  may  therefore  say  that  all  the  evidence  available  points  to  the 
conclusion  that  the  production  of  haemoglobinuria  in  blackwater  fever 
is  consistent  wuth  a  normal  functional  state  of  the  kidney,  and  is  not 
*  l.oc.  cit. 
t  fiber  die  Intoxication  durch  chlorsaiire  Salze,  Virch.  Arch.,  1879,  I!.  77,  S.  455' 
+  liber  die  pathologisch  anatomischen  Veranderungen  in  den  Nieren  und  in 
der  Leber  bei  einigen  mit  llamoglobinurie  Oder  Icterus  verbundenen  Vergiftungen, 
Virch.  Arch.,  1884,  lid.  98,  .S.  460.  Afana.ssiew  regarded  these  granules  as  identical 
with  the  fragments  of  red  cells  seen  in  his  experiments  in  the  circulating  blood;  I 
these  he  describes  as  being  taken  up  by  the  renal  cells  and  passed  on  into  tte 
lumen  of  the  tiibules.  .Vlarchand  and  Ponfick  bold  similar  views. 
