382 DISEASES OF UNCERTAIN .ETIOLOGY 



The taking of quinine does sometimes determine blackwater, but 

 much more often it does not. 



Blackwater fever was known to Europe by Hippocrates and others 

 long before cinchona bark was imported. 



Some assert that quinine will improve and in some cases cure the 

 condition. 



(3) That it is due to a Specific Organism. 



Sambon in 1898 proposed a Babesia. 



Many parasites have been described since. The idea perhaps arose 

 because of a somewhat similar disease in animals caused by a piro- 

 plasmosis. The similarity unfortunately is only superficial for : — 

 With hcemoglohinuria in animals — 



It depends upon infection by a definite organism. 



That organism is present in numbers proportional to the severity 



of the disease. 



Its insect host is well known. 



No previous illness is necessary or usual before the disease is 



manifested. 



If the animal recovers, immunity for it is established. 



All non-immune animals sufifer in proportion to their exposure 



to the infection. 



The symptoms are progressive as a rule, little blood at first, but 



more later. 



There is no natural immunity. 

 With hcemoglohinuria in man — 



No organism except the malarial parasite is constantly found. 



Where malarial fever is absent hcemoglohinuria is absent also. 



Those races relatively immune to malaria are relatively immune 



to blackwater. 



One attack of hcemoglohinuria does not produc«! immunity, but 



perhaps increasingly tends to predispose to another attack. 



The writer had a patient with three attacks within eighteen 



months, each one increasingly dangerous. 



Relapses are not uncommon. 



Most blood is usually passed early; the amount diminishes with 



the disease. 



That it is not in the least infective is against its being of 



parasitic origin. 



Hasmoglobinuria is so acute that the parasite, if one there is, 



must be numerous and possessing high powers of vitality. 



There may be long interv^als between two cases in the same 



district. If a parasite, how does it survive? 



