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the blood contains only crescentic or ovoid bodies and pigmented leucocytes; or, (3) those in which the blood examination is entirely negative and the only evidence of there having been an infection is the presence of endothelial perilobular melanosis. Here the attack of hemoglobinuria does not depend upon the presence of parasites, but begins without apparent cause. Bastianelli finally takes up the quinin hemoglobi- nurias, and asserts that : (a) It occurs only in indi- viduals in whom a malarial infection has been re- cently present; (b) the hemoglobinuric attack is constantly produced every time quinin is adminis- tered, whether it be given while the malaria is in progress (Tamaselli), or when the malarial purchase hoodia infection has run its course (Murri) ; (c) extremely small doses buy hoodia online ofquinin are capable of bringing on an attack; (d) quinin hemoglobinuria has been observed in pa- tients who have already suffered from hemoglobinuria (Murri). The quinin hemoglobinuria he divides into two forms: (1) That occurring during the paroxysm, or paroxysmal hemoglobinuria, and (2) postmalarial hemoglobinuria. In these varieties, through a con- siderable length of time quinin will produce hemo- globinuria whenever it is administered. The course to be pursued depends upon the blood examination. If hemoglobinuria occurs during a malarial paroxysm and parasites are found in the blood, quinin should always be given. If, however, no parasites are found, either as a result of previous administration of quinin or on account of the spontaneous disappearance of the organisms, Bastianelli says that quinin should not be given, owing to the possibility that the paroxysm may have been due to its previous administration. It will be observed that this report of Bastianelli has been quoted at some length and it is hoped that the reader will keep in mind his classification of " quinin hemoglobinuria. ' ' In this connection it might be well to first briefly explain the physiologic action of quinin. Local hoodia buy Action. — When applied upon the mucous membrane quinin exerts a very perceptible stimu- lant or irritant action. It has the same effect when applied to a muscle. Circulation. — Wood states that he has never been able to perceive any depressant action upon the cir- culation in man after ordinary (3 to 5 grains) doses of the drug. In large doses it lowers the arterial pressure, due to action on the heart and its paraly- zant effect upon the vasomotor system. Laveran says that it cannot be classed absolutely either among the stimulants or among the depressants, as its effects differ according to the dose employed. In small doses quinin in healthy men and in rabbits causes an acceleration of the heart's action, and an elevation of the blood-pressure. In large doses it slows the action of the heart. Effect of Quinin on the Blood-Corpuscles and Plasmodium Malaria. — Binz and Schutte have in- vestigated its action upon the red blood-cells, and reached the conclusion that it lessens the power of the hemoglobin to convert oxygen into ozone, therefore it lessens the ozonizing action of the blood. The experiments of Binz go to show that the action of quinin is poisonous to the protoplasm of the or- ganism which causes the disease, in other words, that it is antiparasitic. In his experiments, he showed that in a dilution of 1:20,000 it killed infusoria — Paramecium — beginning within five minutes, and at the end of two hours there was complete dissolution of the organism. Five grains of quinin circulating in order hoodia the blood of a man of average size represents a dilution of 1: 16,000 which is stronger than that with which Binz paralyzed the colpoda within five minutes. Rossbach believes that it deprives the protoplasm of the power hoodia p 57 of absorbing oxygen, thereby forming a combination less easily oxidized than either sub- stance alone. Quinin, having this effect upon protoplasm, it has been supposed that it might limit or destroy the phagocytic action of the white blood corpuscles, but Laveran believes that instead of their action being diminished it is actually increased after its adminis- tration. Effect of Toxic Doses of Quinin. — According to the experiments of Schlockow, Eulenberg, cheap hoodia Briquet, and Cerna there is a lowering of the arterial pressure and the pulse is almost imperceptible at the wrist. The evidence is therefore clear that both in man and in the lower animals quinin in toxic doses is a power- hoodia 57 ful depressant to the heart-muscle and ganglia. Cases in Which Large Doses of Quinin Have purchase hoodia online Been Given without Producing Hemoglobinuria. — Guersent cites a case in which a lady became deaf, dumb, and blind from taking 10 drams of quinin sulphate within the course of a few days. Guiacom- ini spoke of a case in which a man took 3 drams of quinin and who only suffered from symptoms of depression of the heart and nervous system. Briquet records a death following the enormous dose of 55 drams taken within a period of ten days. Digitized by Google April 30, 1898] USE OF QUININ IN MALARIAL HEMOGLOBINURIA.

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