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55 USE OF QUININ IN MALARIAL HEMOGLOBINURIA. [Medical New* supervened have been described by Thayer, Pellarin, Kierner, and Kelsch as follows: The kidneys are somewhat enlarged, the color varying from a deep reddish- brown, to a light yellowish-brown coffee color, often the color is distributed in pale, irregular, pin-head points, and blotches of a maroon-color are to be seen upon the surface, some several millimeters in area. The pyramids are of a deep red color from intratubular hemorrhages. The capsule is easily detached; the consistency of the organ is normal. The epithelium of the convoluted tubules and of the large branches of Henle's loops is very opaque, the nuclei being scarcely visible. The epithelial cells are swollen and bulge into the lumen of the canal. The lumen of the tubule is filled with clumps of amorphous material or casts mixed to a greater or less extent with pigment. The epithelium and lumina of the tubules are filled with large granules often re- sembling casts. Between the glomerulus and capsule, usually near the mouth of the tubule, there is imitrex available generic form often quite a collection of granules, which are also occasionly found in epithelial cells, and sometimes free. In some cases there are small interstitial hemorrhages. The pyramids show few changes. The epithelium is usually intact, though sometimes protruding and vesicular how much does imitrex cost cells suggest that this may take part in the formation of hyaline material. Al- most invariably the tubes are filled with blood- corpuscles. Having before us this vivid description of the morbid anatomy of the kidney of hemoglobinuria (hematuria) one cannot but see that it is a high grade of congestion due to some poison in the system having a profound influence upon the in- ternal organs. What Is the Cause of the Hemoglobinuria! — The law of causation involves the three following buy imitrex online canada af- firmations, each of which is the groundwork of a process of elimination: (i) Whatever antecedent can be left out without prejudice to the effect can be no part of the cause. (2) When an antecedent cannot be left out without the consequent disappearing, such antecedents must be the cause or best price imitrex retail price imitrex part of the cause. (3) An antecedent and a consequent rising and falling together in numeric concomitance are to be held as cause and effect. Possibly the first one of these affirmations is most applicable to this question: Having concurrently a dilute solution of quinin circulating in the blood, together with that of a powerful toxin, such as that formed by the Plasmodium malariae, can it be sup- posed that the former will gain the ascendancy and lead to the production of a condition which the largest doses have always failed to do? Clinical Experience against the Theory of Quinin Hemoglobinuria. — Bastianelli admits that cases of hemoglobinuria following the administration of quinin in malarial fever are very rare in Italy, and that no case has ever price imitrex been reported from the Campagna, but he states that the cases of spontaneous hemoglobinuria due to price imitrex nasal spray quinin increase in buy imitrex online uk number as one goes toward the South. Laveran says he cannot understand why such a condition should be so common in Greece and Italy and so rare in Algiers. In North America let us trace its occurrence as we go toward the^ South: buy imitrex nasal spray online Dr. Ashhurst recently told the writer that he had never seen a case is there a generic form of imitrex of hematuria (hemoglobinuria) produced by quinin, and that he would give quinin for this condition. Anders price imitrex without insurance has seen hemoglobinuria produced in some cases of malarial fever in which quinin had not been taken, and states that it disap- peared upon the administration of this remedy. Osier says that the condition does not exist in the latitude of Baltimore. Thayer, also of Johns Hop- kins, in a recent private communication says that he has never seen a case of hemoglobinuria due to quinin. Dawson of South Carolina says: " I have imitrex generic release date avoided mentioning the theory, again recently dis- cussed by Italian physicians, that quinin may of itself produce hematuria. This theory I believe to be wholly groundless, and it certainly is not maintained by physicians of to day. M Dr. Guiteras says that in his experience imitrex cost canada in Cuba he met with no such cases. Dock, formerly of Texas, but now of Michigan, says that within the last few years, the imitrex generic form subject of hematuria from quinin has been brought up again by physicians in Greece and Italy, but the unusual con- sequences of quinin in the hands of these men make it almost certain they did not have to do with mala- rial hematuria. Consensus of Opinion Regarding the Use of Quinin in Malarial Hemoglobinuria . — Dock (1892): ' The treatment of malarial hematuria, which also includes hemoglobinuria, belongs really to the treatment of acute and chronic malarial poisoning. No American physician at imitrex cost us the present time has any doubt about the propriety of giving quinin in these cases, so that a consideration of that vexed question is unnecessary. ' buy cheap imitrex online ' Thompson (1893) advises that quinin be given hypodermically in imitrex cost per pill this condition. Osier (1895): imitrex generic no prescription "In quinin we possess a specific remedy against malarial infection. In cases of es- tivo-autumnal fever with pernicious symptoms it is necessary to get the system under the influence of buy imitrex injection online quinin as rapidly as possible. In these instances the bisulphate or muriate of quinin and urea should be ad- ministered hypodermically. ' '

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