REVIEW — TEOPICAL MEDICINE, ETC. 



21 



have survived a first attack are put on gradually increasing doses of quinine each day, the Blackwater 

 urine being examined for the presence of hiEmoglobin. If this does not occur in it, and if Fever- 

 there be no rise in temperature, jaundice, or liver pain, the dose is run up to 15 grains, and this continued 

 is then given every 8th or 9th day, with, it is said, the result that neither malaria nor black- 

 water fever occur. Cook himself employs Hearsey's treatment with apparently good results. 



Mayer' described an interesting case which was treated by four-hourly saline enemata 

 day and night — one pint being given at a time, during the height of the fever. Quinine was 

 added to some of the latter enemata. The patient made a good recovery and the author 

 notes that he was remarkably comfortable, that there was no vomiting during the whole 

 course of the illness, that there was a regular rise of temperature every evening probably due 

 to his being supplied with fluid, and that this rise yielded to treatment with small doses of 

 quinine freely diluted. It should be noted, however, that the nursing was apparently ample 

 and good. 



Skelton- (Sierra Leone) distinguishes between hsemoglobinuric paludism (true black- 

 water) and quinine intoxication. He gives quinine by rectal injection, lirst of all 

 administering a soap and water enema. The medicinal enema consists of quinine sulphate 

 5 grains, dilute hydrochloric acid q.s. to dissolve the quinine, and warm water 3 ounces. 

 He gives opium for vomiting, 1/3 grain morphia repeated, if necessary, in 6 hours. As soon 

 as the stomach will retain it he gives quinine by the mouth. 



Dammermann''* reports favourably on the use of the decoction of the leaves of an African 

 plant, Combretits raimbaHthins, together with milk and potassium acetate. He gives his 

 decoction in a strength of 24 parts to 1500 of water as a prophylactic to persons in whom 

 quinine is apt to induce blackwater. 



A practical point is mentioned by Mense,"** who finds that the kidneys are well flushed 

 by large quantities of warm tea, best sucked through a tube, as this method tends to prevent 

 vomiting. For this symptom Gush'' recommends an effervescing mixture of carbonate of 

 ammonia, sodium bicarbonate and citric acid. I have examined several blood films from 

 blackwater cases occurring in the Bahr-El-Ghazal and have never found parasites of any 

 kind present. In one case, which terminated fatally in Khartoum and has been recorded by 

 Crispin,'' I found the urine, which was at the time free from hasmoglobin, loaded with uric 

 acid. This case was from the Blue Nile, but the patient had previously suifered from the 

 disease in Central Africa. Eecently, a primary case has occurred at Eoseires on the Blue 

 Nile, a place with an evil reputation for malaria. One cannot, however, be quite certain if 

 this was a true blackwater case or a severe case of malaria in which haemoglobinuria 

 occurred. 



Blood. Under this heading no allusion will be made to blood parasites. It is 

 intended to deal very briefly with questions of morphology, clinical technique and medico- 

 legal examinations which may furnish useful information to workers in the Sudan and other 

 tropical countries. 



Ilankiu^ describes methods for the recognition of blood and seminal stains, especially 

 in tropical climates. He points out that the high temperature of tropical climates 

 has a two-fold action on blood and seminal stains. If the latter are kept damp 

 they are apt to putrefy, if dry they become so insoluble as to be acted on with 

 difficulty by ordinary reagents. In a blood stain so altered he finds that the absorption 

 bands of haemochromogen can be obtained, even when the blood-colouring matter is in an 

 apparently undissolved and insoluble condition, by the following method : — 



If on clothing, cut the stain out and plunge into boiling water for a few moments. Then 

 place on a glass slide and wet with ammonium sulphide. Examine under the microscope 



1 Mayer, T. F. Q. (December 2ucl, 1907), "A Case of Blackwater Fever, Treated by Saline Enemata." 

 Journal of Tropical Medicine, p. 378, Vol. X. 



' Skeltou, D. S. (June, 1908), " Some Observations on Blackwater Fever." Journal of the Rnijal Army 

 Medical Corps. 



" Dammermann, Deutsche Mai. IFochen, 1906, No. 23. 



■* Mense, Arch. f. Schijfs. u. Trop. Uijy., January, 1906. 



^ Gush, H. W. (December 16th, 1907), "Prophylactic and Remedial Treatment of Blackwater Fever." 

 Journal of Tropical Medicine and Hijijicnc, p. 401, 'Vol. X. 



« Crispin, E. S. (August 5th, 1905), "A Case of Blackwater Fever." Lancet, p. 357, 'Vol. II. 

 ' Hankin, E. H. (November 10th, 1906), " Methods for the Recognition of Blood and Seminal Stains 

 Especially in Tropical Climates." British Medical Journal, pp. 1261, 1843, '7ol. II. 



* Article not consulted in the original. 



