Tlie  percentaf^e  of  haemog-lobin  in  the  urine  lay,  in  the  cases  in 
which  this  could  be  determined,  between  0'2  |rer  cent,  and  3'8  per 
cent.  (Table  43,  p.  136).  The  total  amount  of  haemngdobin,  lost  in 
the  urine,  ranged  between  r5  g.  and  75  g.  (Fable  45,  p.  141).  The 
total  amount  of  dissolved  haemoglobin  entering  the  blood  plasma 
could  not  be  determined  (cp.  p.  143).  Methaemoglobin  was  also 
usually  observed  in  llie  urine  in  relatively  small  amount.  Red  blood 
cells  were  found  in  the  urine  (Table  43).  Casts,  generally  granular  in 
character,  were  always  present  (Section  IV,  p.  94;  h  igs.  21  to  32). 
The  urine  before  and  after  the  attack  was  frequently  high  coloured, 
as  in  Cases  2  and  7,  for  example.  Bile  pigment  was  not  found  in  the 
urine. 
In  Cases  7a  and  n  (suppression  of  urine)  and  in  Case  16  (death 
seven  days  after  blackw'ater  had  ceased)  some  of  the  renal  tubules,  in 
particular  the  collecting  tubules,  were  found  to  be  plugged  with 
coarsely  granular  casts  (Figs.  33-40  and  53-56)  resembling  those 
present  in  the  urine  in  Case  7a  (Figs.  29  and  32).  The  renal 
epithelium  did  not  show  any  marked  degenerative  changes.  The 
condition  of  the  urine  during  nine  days’  suppression  is  given  on  p.  igg 
(Case  7a)  and  on  pp.  220-221  (Case  1 1). 
The  spleen  was  observed  to  be  enlarged,  usually  markedly  so,  in 
all  cases  except  13  and  15,  in  which  no  information  as  to  its  condition 
w'as  available  (Table  47,  p.  154) 
Hlackwater  Fever.  Case  r. 
Male,  twenty-nine  years  of  age.  Engineer.  European. 
Idas  lived  in  Nyasaland  for  the  last  five  years.  During  this  period 
he  has  suffered  a  good  deal  from  fever.  Has  ha,d  one  previous  attack  of 
blackwater  fever  about  three  years  ago.  fde  does  not  take  quinine 
regularly.  About  a  month  ago  he  suffered  from  low  intermittent 
fever.  Fie  stated  that  he  had  an  attack  of  fever  each  alternate 
afternoon  about  3  p.m.  These  relapses  went  on  for  about  a  fortnight, 
and  during  this  time  he  took  no  quinine.  After  these  attacks  of  fever 
had  stopped,  he  took  five  grains  of  quinine  daily  for  three  or  four 
days.  During  the  next  fourteen  days  he  felt  very  well,  and  took  no 
quinine 
