3 2 3 
(in which it appears legitimate to assume the haemolysis took place), 
occupied about thirty-six hours. So the haemoglobin of about 0 6 per 
cent, of red corpuscles was discharged into the plasma in every hour, 
if the haemolysis was spread evenly over the period of the crisis; 
and as the liver would need to remove this amount every hour from 
the whole blood to prevent the appearance of haemoglobinuria, any 
slight failure of the mechanism either from hepatic congestion or 
from all the haemolysis occurring in a very short period of time might 
serve to set up haemoglobinuria. 
CONCLUSIONS 
1. The main excretory channel for the pigment portion of the 
blood is the alimentary tract, and urinary urooinn represents only 
a small overflow from this source ; the main elimination is in the 
faeces, and this has been largely neglected by previous observers, 
in favour of the urinary overflow ; which, however, would seem to be 
of importance only as an indication of the absorptive activity of the 
intestine and almost negligible for quantitative purposes. 
2. That the fall in the haemoglobinometer readings in malaria 
appears to represent an actual destruction of red corpuscles and 
elimination of their pigment by the normal excretory mechanism. 
3 - The haemoglobin breakdown during the pyrexia due to 
malignant tertian (P. falciparum) infection appears to be greater 
than in other pyrexial diseases or than in benign malaria (P. vivax), 
and may be many times greater than would be accounted for by the 
number of corpuscles infected by the parasites. 
4 - 1 'hat as regards their effect of causing haemolysis, the 
parasites appear to be of different degrees of virulence in different 
individuals, and even in different paroxysms in the same individual 
(relatively at least, since the patent’s resistance must be considered). 
5 - Normally the ordinary channels of excretion are capable of 
dealing with the free haemoglobin and rapidly remove it from the 
blood stream, and a very severe strain (over 25 per cent, of the total 
circulatory haemoglobin) can be sustained without their failure and 
the consequent onset of haemoglobinuria. 
