continued 



20 BEVIEW — TEOPICAL MEDICINE, ETC. 



Blackwater as one of the essential factors. I merely mention it here as I can find no reference to its 

 Fever— having been noted in connection with blackwater fever. 



Christophers and Bentley' observed a phagocytosis of rod blood corpuscles in the spleen 

 of a case of blackwater fever. They specially note that the engulphed erythrocytes con- 

 tained no parasites, so that the condition is different from what is seen in canine 

 piroplasmosis where the phagocytosed red colls always contain piroplasmata. They strongly 

 incline to the view that blackwater fever is the result of malarial infection. As regards the 

 significance of the condition they describe, they think that if the phagocytosis of apparently 

 normal red cells be taken in conjunction with the generally recognised fact that exposure 

 for a certain time to malarious conditions is necessary before blackwater fever can be con- 

 tracted, then it must be admitted that under certain conditions at some stage in the process 

 of malarial immunisation, a process which is known in some degree to occur, there results 

 a liberation of specific poison from the red cells, causing the extensive destruction of these 

 elements which is the essential feature of the disease. 



To medical officers in the Sudan, notes on new or recent methods of treatment are likely 

 to be more serviceable than a recounting of various etiological theories. 



Vedy,-* a French doctor with much experience, believes the disease to be due to a toxin 

 probably elaborated by a special micro-organism. His routine treatment consists of free 

 purgation followed by frequent enemata, and in serious cases saline infusion. These measures 

 are for the elimination of the supposed toxin, and are supplemented by the administration of 

 warm water and weak tea by the mouth. Symptoms are treated as they arise ; tendencj' 

 to heart-failure, by caffeine and champagne ; vomiting after the first day, by morphine and 

 counter-irritation. The use of antipyretics and digitalis is contra-indicated, while pilocarpine 

 is stated to be dangerous in this disease. This author also gives useful rules as regards the 

 giving or withholding of quinine. 



1. If, twenty- four hours after the onset, malaria parasites are present in the blood, give 

 a small dose (12 grains) of quinine. 



2. Never give quinine if malaria parasites are not present in the blood. 



3. If in doubt (if an examination of the blood is not practicable), do not give quinine. 



Hearsey's method, which is a modification of that of Sternberg for yellow fever, consists 

 in the administration of 10 grains of sodium bicarbonate and 30 minims of the liquor 

 hydrargyri perchloridi. The mixture is given every two hours for the first twenty-four hours 

 and thereafter every three hours until the urine is free from hemoglobin. Hearsey" recorded 

 18 consecutive cases treated in this way without a single death. The accompanying treat- 

 ment consisted of milk and barley water given frequently and in small quantities. Cham- 

 pagne and acid drinks are eschewed, brandy being the stimulant employed when required. 

 Benger's food is stated to be of great value. During convalescence the scaly preparations 

 of iron were found most suitable as blood tonics. 



Boxer'' lays great stress on proper nursing and rectal feeding. He condemns the 

 exhibition of quinine and thinks all drugs are better avoided, except perhaps calomel given 

 as a purgative. 



Owing to its anti-hoemolytic action, Vincent' recommended the administration of 

 chloride of calcium in doses of 4 to 6 grammes by the mouth, or 1 to 2 grammes 

 subcutaneously dissolved in physiological salt solution. 



Hartigan" suggests, but it is merely a suggestion, the use of euquinine, the ethyl- 

 carbonate, owing to its being a non-irritant, while Cook, quoted by Harford," describes the 

 practice in vogue in the German colonies, where cases are not invalided home, but if they 



' Christophers, S. R., and Bentley, C. A. (March, 1908), "Note on the Phagocyto.sis of Red Blood Corpuscles 

 in the Spleen of a Case of Blackwater Fever. Itulian Medical Gazette, Vol. XLIII., No. 3. 



^ Vedy, L., " La fievre bilieuse ha>moglobinurique dans le basin du Congo." Paris, A. Maloine, 1907. 



' Hearsey, H. (March 5th, 1904), "The Treatment of Haemoglobinurio Fever." British Medical Journal, 

 p. 544, Vol. I. 



■• Boxer, E. A. (May 7th, 1904), " Haemoglobinuric Fever." British Medical Journal, p. 1078, Vol. I. 



' Vincent, H., C. K. Soc. Biol., t. LIX., 1905, pp. 633, 635. 



" Hartigan, W. (January 15th, 1907), " Euquinine — Its Suggested Use in Blackwater Fever." Journal of 

 Tropical Medicine and Uygiene, p. 17, Vol. X. 



■» Arch. f. Schiffs. n. Trop. Jlijg., January, 1906. 



* Article not consulted in the original. 



