110 TROPICAL MEDICINE AND HYGIENE 



albuminuria. Parotiditis has been known to occur, and 

 hepatic abscess may follow an attack of blackwater fever. 

 Retinal haemorrhages or haemorrhages into the vitreous 

 may lead to impaired vision, but in such cases complete 

 recovery of sight is usual. 



Piroplasma. Piroplasmata have been frequently looked 

 for but never found, as has been already mentioned. 

 There is no relation known between the distribution 

 of any species of tick and blackwater fever, but more 

 work in this direction is required. The distribution 

 of Ornithodorus moubata does not correspond with that 

 of blackwater fever. Leishman has described bodies, 

 which he suggests may be parasites, of the nature of 

 Chlamydozoa in the leucocytes ; but it is doubtful if the 

 bodies he describes are not inclusion forms of remnants 

 of broken-down blood-cells, as similar appearances are 

 seen in the blood in cases of other diseases having no 

 connection with blackwater fever. 



Prophylaxis. The close relationship in Africa between 

 the distribution of blackwater fever and of great liability 

 to malarial infection points to the desirability of dealing 

 with the malaria. 



Persons in whom quinine produces haemoglobinuria 

 are unsuited for residence in a malarial country. In 

 such persons it is sometimes possible to treat the malaria 

 with quinine, if small doses of quinine, very gradually 

 increased, are employed. Persons who have never had 

 blackwater fever in Africa are still liable to an attack for 

 some months after their arrival in England. It is therefore 

 advisable that the regular prophylactic use of quinine 

 should be continued, not only on the voyage home, but 

 for two or three months after arrival in England. Such 

 persons must also avoid exposure to chill, over-fatigue, 

 or any depressing influences. 



A previous attack of blackwater fever appears to pre- 

 dispose to other attacks. A single severe attack or two 

 milder attacks should be considered as disqualifying that 

 person for residence in an endemic area. 



