BLACKWATER FEVER 107 



Under these circumstances the advisability of remov- 

 ing the patient to a place where he can receive skilled 

 care has often to be considered. If moved at all, he 

 should be moved early, in the first day of the disease. 

 Later the risk of collapse is enormously increased by 

 any journey, and after the first day should not be under- 

 taken. Even on the first day, the risks, on the whole, 

 of moving the patient are at least as great as the advan- 

 tages resulting from the more careful attention would be. 



If moved, the patient must be carried in a recumbent 

 position. A hammock is as good a method as any. He 

 must be well wrapped up and receive water frequently 

 whilst on the roa'd, and food in addition if the journey 

 be a long one. 



Food must be fluid and nutritious : it is well digested. 



During convalescence great care must still be exercised 

 both to prevent chill and exposure, for fear of relapses, 

 and to avoid over-exertion or anything that may throw 

 any strain on the heart, as fatal syncope may occur 

 during this period. 



Constipation during the early stages is not of import- 

 ance, and should not be relieved till the urine is clear ; 

 later the bowels must be kept open, preferably by mild 

 saline aperients. 



Etiology. The true cause of blackwater fever is 

 unknown. It occurs in both sexes, but is not known 

 in early childhood. It does occur in negroes, but not 

 in the native negroes in an area where the disease is 

 endemic. In proportion to their numbers it is more 

 common amongst Europeans than amongst Asiatics. In 

 Europeans it rarely occurs during the first six months 

 of residence in an endemic area, but after that period 

 becomes more common, and is most common in the 

 second and third year of residence. In Panama the 

 incidence appears to be rather different, as the number of 

 cases in the first two years of residence is nearly equal, 

 and in the first three months the incidence is at the same 

 rate as for the first two years. First attacks are very rare 



