\-]l 
qiuinnc  may  he  less  Ilian  that  ol  wilhlidldiii)^'  ll.  SoinelimL's 
Ihe  derision  may  be  lefl  to  llu'  patient,  hut  in  most  cases  Hip 
responsibility  of  deeidmff  upon  tlu'  Ireidmeni  will  neressaialy  rest 
with  Ihe  medical  olTieer.  W’e  are  ol  opinion  that  Ihe  jfeiiernl 
avoidance  of  (juinine  in  malarial  cases  with  a  view  to  esea|imj;  the 
possible  risk  of  blaekwater  fever  would  expose  patients  to  a  nuidi 
{greater  risk  of  fatal  issm'  from  complications  ol  malaria.  ’I'lie  dcfiTPc 
of  risk  involved  in  j^ivin^'  quinine  shortly  alter  an  attack  of  blackwalpr 
fever  may  lae  judged  Ironi  a,  f^lance  at  1  aJile  S''  (C  ases  S,  12,  1  la), 
It  is  scarcely  necessary  to  add  that  when  quinine  is  o'iven  its  usp 
should  be  continued  as  Ion”  as  splenic  enlarf^'emmil  or  oilier  sij,ui  at 
malaria  is  observable. 
During-  the  alturk  of  lilackwater  fever  (juinine  is  probably  hpsl 
avoided,  but  when  haemog-lobiniiria  has  ceased  and  Ihe  temiiei-iiliirc 
has  become  normal,  Ihe  treatment  of  I  be  accomiianying  malarial 
condition  may  be  commenced  with  gr.  daily  doses  cil  r|uininc;  very 
small  doses  appearing  to  be  much  less  likely  lo  cause  liaemoglobiiiiiria 
than  larger  doses.  I’liis  amount  may  be  gradually  increased  lo  5  gr. 
a  day  (cji.  (ia.se  i.|a.  Table  48). 
Of  ibe  treat nieni  of  Ihe  general  symploms  ol  blaekwater  lever 
nothing  will  be  said,  since  these  are  dealt  with  by  Ihe  same  mellidils 
which  are  employed  when  Ihey  occur  in  other  diseases.  Our 
e.xpericnce  does  not  enable  us  lo  express  any  opinion  as  to  lIu'  value  of 
the  numerous  enipirii'al  melhods  for  the  treat numl  of  blac’kwaler  fever 
which  ha.ve  fieen  pul  forward  liy  various  aiilTiors,  A  few  remarks 
may,  however,  be  made  on  tbe  treatment  of  a  com|iheal  ion  which  is 
peculiar  to  blaekwater  fever  and  is  a,  fre(|uenl  caaise  of  death,  namely, 
sup]iression  of  urine.  It  lias  already  been  [lointed  out  that  the 
tendency  to  [dugging  of  Ihe  renal  tubules  with  granular  maleriiil, 
which  is  i^iirely  mechanical  in  its  action,  appears  less  likely  lo  iicciir 
when  the  How  of  urine  is  rapid  than  when  it  is  sluggish.  Tor  ibis 
rea.son  in  all  cases  of  bhickwater  fever,  and  especially  when  Ihf 
amoiinl  of  urine  secreted  is  small,  which  is  likely  lo  be  ihe  rasr 
when  the  patient  has  been  sweating  jirofiisely,  as  often  ba|i|)eiis, 
or  exhibits  signs  of  cardiac  depression,  the  sccrelion  of  urine  by 
Ihe  patient  should  be  eni'oiiraged  by  the  administration  of  a  copious 
amount  of  Ihiid  lo  drink  and  by  the  use  of  lea,  cafleiiu', 
digitalis  or  other  diuretics.  If  .supjiression  has  su|)ervened  ibc'sr 
