of bile be excessive it gives rise to what are called " bilious symptoms "—— bilious vomiting, bilious diarrhœa—— symptoms which are so common in malarial disease, particularly in that variety known as "bilious remittent." Thus, polycholia is a constant and often urgent feature in most malarial fevers, and is good evidence that in malarial infections there is a surcharge of the blood with free hæmoglobin. It is not improbable, although this point is disputed, that the yellowness of the skin and scleræ observed in these fevers is due to tinting by free hæmoglobin, to a hæmoglobinæmia in fact, and not, as is popularly be- lieved, to biliousness or cholæmia from bile absorption.
The yellow pigment is deposited in excessive hœmoglobinœmia.—— As in those other conditions referred to as being attended by rapid hæmolysis, in severe malarial fevers in which there is great and sudden liberation of hæmoglobin which the liver cannot at once deal with, pending its transformation into bile pigment the liberated hæmoglobin is taken up by the protoplasm of the cells of the different tissues and organs of the body, and precipitated in them in a slightly altered form; it is stored up, in fact, waiting to be worked off as bile pigment by the, for the time being, overtaxed liver. The yellow pigment is, in all probability, this precipitated hæmoglobin.
Great excess of hœmoglobinœmia results in hœmoglobinuria.—— Should the liberation of hæmoglobin go beyond this, be too great and too suddenly effected fov the excretory powers of the liver and the storage capacity of the tissues, then the hæmoglobin, little altered in composition, seeks a more speedy way of escape by the kidneys, and hæmoglobinuria is produced. This is what is found in ordinary paroxysmal hæmoglobinuria, and in toxic hæmoglobinuria; and in this way we may account for the peculiar features of the disease to be described later on hæmoglobinuric fever.
Size and shape of the blood-corpuscles.—— On the whole, in malaria, as in most anæmic conditions, the corpuscles are larger than normal particularly those attacked by the parasite, especially the tertian para-
