REVIEW TEOPICAL MEDICINE, ETC. 19 



than that of Ascaris lurtibricoides is very important for the novice in faecal examinations Bilharziosis 

 to note. — continued 



Dr. Low's^ note on making permanent preparations of bilharzia eggs may be quoted. 

 The little shreds of mucus passed with the urine are mounted in glycerin jelly and the 

 cover slips ringed with Canada balsam or asphalt. 



It is perhaps worth mentioning here that there is a Schistosomum bovis of cattle and 

 sheep, first described by Sonsino in Egypt, while Montgomery- describes a new species 

 S. indicum, affecting horses and donkeys in India, and has also found two new species, 

 8. bomfordi and iS'. spindalis, in Indian cattle. He also records the fact that a very large 

 number of human cases were introduced into India from South Africa, and that the former 

 country is evidently well-suited to the propagation of the Bilharzia parasite. 



That bilharziosis occurs and is endemic in the Sudan has been shown in the First and 

 Second Eeports of these Laboratories. Only S. luematohium has, so far, been found. That 

 it is also frequently being introduced from Egypt there can be no doubt, and as irrigation 

 schemes increase, so will, in all probability, the amount of bilharziosis. At present the 

 infection is probably limited, as regards its source, to the Nile, though, if the view be correct 

 that the embryo reaches its human host in the body of some crustacean, then well-water may 

 also be implicated. Time has not permitted further experiments with the species of 

 Ostracode mentioned in the Second Report, but certainly the results obtained were suggestive. 

 It is difiScult to know if anything could be done to check the probable increase of this 

 disease. At present it is not much in evidence, save amongst those who have lived in Egj'pt, 

 and, strictly speaking, it would be well to guard the Sudan against it in somewhat the same 

 manner as has been suggested for ankylostomiasis. Practically, however, any such scheme 

 would, under existing conditions, almost seem impossible of realisation, though, if it could be 

 properly carried out, the urine of immigrants likely to be bilharzia-carriers systematically 

 examined, and those found infected refused admittance to the country or, at least, placed 

 under medical control, I believe a possible danger might be averted. Bilharziosis is a serious 

 menace to health in South Africa and fills the hospitals in Egypt. Hence it would be well to 

 limit it as much as possible in the Sudan, and a sanitary policy directed to this end, though 

 it may be regarded as Utopian, has much to commend it, while if it is to be introduced at all, 

 the present is the time for action. 



Blackwater Fever. The precise nature of this dreaded complaint, and one which 

 has taken toll of several valuable lives in the Sudan, still remains unsolved. The chief 

 views regarding it are : — 



1. It is due to quinine acting under certain conditions and usually on a person the 

 subject of malaria. This view is quite untenable, as is clearly shown by Manson.'' At the 

 same time, quinine can and does produce haemoglobinuria. This is one of the rarer toxic 

 effects of the drug. 



2. It is a manifestation of malaria, either a severe form of the disease or a symptom 

 of the concurrence of a kidney lesion with malaria, a view strongly urged by Plehn. 

 Buchanan'' has pointed out that three factors may be operative — malaria, quinine and the 

 kidney lesion. 



3. That it is a specific disease due to a special blood j)arasite, in all probability one of 

 the piroplasmata, which may be conveyed from the sick to the sound by means of ticks. 



Having seen very little blackwater fever, one has no opinion to offer, but an obseiwation 

 by a layman who has had great experience of the disease, and has lost many friends and 

 companions by reason of it, may not be without interest. He informs me that at least half 

 the cases which came under his notice had recently suffered from acute gonorrhea. This 

 may have resulted merely in a lowering of general vitality, rendering the patients more liable 

 to serious disease ; and, of course, it is certainly not operative in many cases of blackwater 

 fever, but it may possess some interest in view of the theory which regards a kidney lesion 



' Low, Q. C. (February 16th, 1907). " Method of mounting specimens of Bilharzia eggs, embryos, etc." 

 Jauriial of Tropical Medicine, p. 67, Vol. V. 



° Montgomery, R. E. (January and February, 1906), " Observations on Bilharziosis among Animals in 

 India." Journal of Tropical Veterinary Science, p. 15, Vol. I. 



" Manson, Sir P.ttrick (1907), " Tropical Diseases." 4th Edition. 



* Buchanan, W. J. (April 27th, 1907), " The Third Factor in the Etiology of Blackwater Fever." British 

 Medical Journal, p. 990, Vol. I. 



