BLACKWATER FEVER 9 1 



-easily relieved by enemata if necessary. These must be 

 used with great caution, and purgatives, in the opinion 

 of the writer, should not be given during this stage. 

 Some authorities advocate free purgation with calomel or 

 other drastic purgatives. 



The temperature remains high, and there maybe hyper- 

 pyrexia, but it falls as the haemoglobinuria diminishes. 

 There may be only the initial rigor, but frequently there 

 is more than one, and sometimes there are several each 

 day. There is always nausea, and frequently vomiting. 

 This may be so severe that the smallest amounts of food 

 or fluid are returned as soon as they are taken. Very 

 rarely there is haematemesis ; commonly there may be 

 streaks of blood if the vomiting be violent (figs. 28 and 29). 



Hiccough is common, and may be so incessant that it 

 becomes a source of danger from the exhaustion induced. 

 The prognosis is unfavourable if there is much hiccough. 

 When only occasional it has no prognostic value. There 

 is usually no pain after the onset, not even headache, but 

 sometimes there is aching pain in the loins, and the 

 abdominal or hepatic pain present at the onset already 

 mentioned may recur and become continuous. 



The rapid development of extreme anaemia is most 

 important. The red blood corpuscles in the course of three 

 days may be reduced to 1,000,000, or even less, per cubic 

 millimetre. The remaining blood corpuscles may be 

 much changed, many being mere shadows devoid of 

 haemoglobin, or appear fairly normal and above the 

 average tonicity. Associated with this anaemia is extreme 

 debility, and violent palpitations on the slightest exertion. 

 Death from syncope may occur during attempts at defae- 

 cation or even micturition. 



The duration of this stage of hasmoglobinuria varies 

 greatly ; it may last only two or three hours, but usually, 

 in a moderately severe case, from two to three days. If 

 it lasts more than two days the prognosis is very grave, 

 unless the prolongation is due to the occurrence of 

 relapses. A series of relapses, in each of which the 



