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burning sensation during the acuter stages of illness. Further, assuming that the deep-red
aspect of the , urine was due to an abundance of urobilin pigment, it may be noted that
urobilin can be formed from bilirubin, and that bilirubin is now generally supposed to be
formed from hæmoglobin ; such transformation being, however, commonly thought to take
place within the liver, which did not appear so much implicated as the spleen in this case.
A small quantity of urobilin being present in normal urine, urobilinuria has been regarded
as only the exaggeration of a physiological phenomenon ; and indicative of insufficiency
or, if prolonged, of disorganisation of the hepatic cells. Doubtless hepatic derangement
ensues on the malarial infection ; yet secondarily, I should say, to the splenic ; and I
would connect, in this instance at least, the state of the urine with that of the blood. Ad-
mittedly, the pigmented organisms were here so few that they might have been overlooked,
but they were present : and the malarial nature of the blood and urine-changes which pre-
vailed, was, I may add, collaterally shown by the, fact of the patient's wife, who worked in
the fields with him, displaying in hospital marked paroxysmal fever. Thereupon her blood was
examined and found to contain unmistakeable parasites, both sessile on the red discs and
free as spheroids and crescents ; the phagocyte phenomenon being as well evident. The
liver and spleen were even much more considerably enlarged, yet the urine was merely
high-coloured and did not contain any albumen : the specific fever was checked by
quinine in her, as readily as in her husband's case.
Summarising the whole data, I consider there is proof enough that the genuine “Ague-
state”—the ‘ “malaria-process’ ” in older term and in new the “malaria-infection”—is pa-
thologically distinguished by a visible living blood-contamination ( a ) , having hæmatozoic
rather than hæmatophytal affinities ( b ) , and displaying a relationship to clinical symptoms
which, if often less precise than obtains with pathogenic bacterial infections, may none the
less be real (c ). Further, it has been shown that in arresting malarial pyrexia, the drug
quinine does not with equal promptitude annihilate the blood-parasite (d) ; this datum also
indicating a probable different relationship of phenomena, in the monadic as compared with
bacteric infection. That the hæmatozoa undoubtedly present in ague, holds a close, if not
causal, relation to that disease, may be inferred from first their constituting an adequate
pathogenic influence, and next their exclusive limitation to this one morbid affection : nor
need such influence be annulled by seemingly conflicting evidence regarding the details of
association. According to my observations, the visible blood-contamination may be more
constant and uniform than concurrent pyrexial phenomena ; and hence the inference that
i t i s fundament al , whi l st ‘fever’ i s rat her a cont i ngent event . Cert ai nl y not al l fever i n
malarious subjects is necessarily monad-pyrexia ; and by experience I have been led to re-
cognise at least three forms of such ‘fever’—namely, first the genuine specific form, with
its positive blood-aspects ; next and oftener in old cases, the consecutive residual or quasi-
reactive form with its negative blood-state, which may have simulated the genuine type in a
clinical sense ; and, lastly, the pyrexia pertaining to a superadded infection, which for a time
supersedes the monadic—as, for example, was demonstrated for enteric fever by Dr. La-
veran (l. c., p. 378). As to nature and causation, I would add that present results serve to
explain the paroxysmal and periodic character of paludal fever, through the corresponding
definite duration and reproduction of a living contagium. That such pathogenic agent
should be zooic rather than phytal, is a datum of etiological import ; because Infusorial life
is known to prevail under different and more restricted condition than the Bacterial, and
hereby a clue may be gained as to the sources of ague-infection. The foreign and non-
descript term of “Malaria” adopted in Britain since 1827, may soon have to be abandoned