HEMOGLOBIN URIC FEVER 387 



The blood is thin, watery, diminished tonicity, red cells and hb, 

 much reduced showing degenerative changes. Malarial parasites or 

 pigment may be seen. 



There is leucocytosis during the fever, leucopenia with a mono- 

 nuclear increase afterwards. 



The urine is yellow, dark red, blackish. Diluted, the spectroscope 

 shows oxy- or meth-ha?moglobin, low specific gravity, a dark brown 

 granular deposit from destroyed blood cells. When boiled and allowed 

 to stand for some time a bright purple colour develops (Plhen's 

 reaction). The urine does not decompose for some time. 



Albumin is plentiful. Phosphates are diminished. Urobilin can 

 be seen with the spectroscope after acidulating the urine with acetic 

 acid and extracting witli amyl alcohol. 



SYMPTOMATOLOGY. 



As a rule the patient has had recurrent malarial attacks, and has 

 taken quinine spasmodically or not at all. White people are more 

 prone to it than coloured. 



Prodromata are often absent. When present there mav be lassi- 

 tude, general pains, loss of appetite, restlessness, yellow tinging of 

 skin and conjunctivae. 



Course: shivering fits, headache, severe pains in back, hiccough, 

 nausea, retching, vomiting food, then green bile. Excessive thirst,, 

 constipation, urgent desire to micturate. Liver and spleen tender, 

 skin hot and dry, yellow skin and conjunctiva. Temperature rises 

 rapidly to io3°-i04° F., pulse 100-120, small, regular, readily com- 

 pressible. Blackish urine with burning sensation of the urethra. 



After a few hours perspiration sets in, temperature falls to 100° F., 

 the urine clears, convalescence begins, or in a severe case vomiting 

 increases, temperature again rises, diarrhoea sets in with bilious 

 motions and blood. Some recover, others die of exhaustion, hyper- 

 pyrexia, coma, anuria, and ura?mia as a result of this or successive 

 attacks. 



In any cases of recovery convalescence is much protracted. 



There is always grave anaemia. 



The mortality varies from 4 per cent, to 50 per cent. 



The figures on the West Coast are of interest, as compared with 

 those of East Africa and Nyasaland : — 



