HJEMOGLOBINURIC FEVER 381. 



It appears to have some dependence upon meterological conditions. 

 It attacked the Chinese labourers when building the Congo railway. 

 It attacked the labourers constructing the Corinth canal. 

 It attacked the Chinese army at Kwangsi like a plague. 

 It attacked the prisoners in Sardinia in 1885. 



AETIOLOGY. 



Theories. — These are numerous. The chief are as follows : — 

 (i) A manifestation of an active malarial infection. 



(2) The result of quinine poisoning. 



(3) That it is due to a specific organism. 



(4) That it is a condition brought about by previous malarial 

 infection. 



(1) That it is a Manifestation of an active Malarial Infection. 

 Pro. It has been pointed out : — 



(i) That where the malarial mortality is high, blackwater 

 fever is not uncommon, but it is scarce where the 

 malarial mortality is low. 



(2) That people attacked with blackwater fever had pre- 

 viously suffered from malaria and had usually been 

 attacked several times. 



(3) That the day preceding the hsemoglobinuria the 

 patient's blood contained parasites in 95'6 per cent, of 

 cases, while the day after the attack they were seen in 

 only 1 7" I per cent, of cases (Stephens). 



(4) That there is found a monoieucocytosis. 

 Con : — 



(i) That it has occurred in people who have never had 

 malaria. 



(2) That it is uninfluenced bv quinine. 



(3) That in Panama h^emoglobinuria is rare, but acute 

 malarial infection very common. This view is not 

 widely held. Most seem to agree that acute malaria 

 may be the exciting factor, but that some other agent 

 is necessary. 



(4) That blackwater is rare in some districts where malaria 

 is most rife. 



(2) That it is the Result of Quinine Poisoning (Koch). 

 This view is not widely held because — 



Quinine administered to patients without previous malaria has never 

 caused hasmoglobinuric fever, no matter how great the dose. 



H^moglobinuric fever has occurred when no quinine has been 

 administered. 



