I2l6 



THE TROPICAL HEMOGLOBINURIAS 



both macroscopically and to some extent microscopically the 

 kidney seen in blackwater fever. 



Symptomatology.^ — ^The general symptoms resemble those of an 

 attack of blackwater fever, but are not so severe, and the jaundice 

 is slight or absent. 



Diagnosis. — ^The history of the attack following the administra- 

 tion of quinine in persons suffering from malaria cachexia or chronic 

 malaria may give a clue. 



It is suggested that the rate of haemolysis of the erythrocytes, when treated 

 with quinine, may be compared with that for normal erythrocytes similarly - 

 treated. The method adopted to test haemolysis is to allow i c.c. of blood 

 from the pricked finger to fall drop by drop into a i per cent, solution of 

 potassium oxalate, which also contains 0'45 per cent, of sodium chloride, until 

 a proportion of four parts of blood to one part of the oxalate is reached. Then 

 the mixture is added to lo c.c. of a 0*9 per cent, solution of sodium chloride, 

 and centrifugalized until the red cells are completely precipitated, when the 

 supernatant fluid is pipetted off, and then sufficient 0-9 per cent, solution of 

 sodium chloride is added to make a 2*5 per cent, emulsion of red cells. This 

 emulsion is then placed in a series of test-tubes containing various strengths 

 of an isotonic solution of quinine made up with 0*9 per cent, sodium chloride 

 when necessary. The tubes are incubated for three hours at 37° G., and 

 stirred with a glass rod every fifteen minutes, and the result noted at the end 

 of the time. 



Prognosis. — ^This is usually good. 



Treatment. — Quinine administration should be stopped, and 

 calcium lactate administered, and the ordinary treatment for black- 

 water fever as indicated below should be carried out. 



Prophylaxis. — Europeans about to visit or reside in the tropics 

 should be given a test dose of 10 or 15 grains of quinine by the mouth, 

 in order to exclude idiosyncrasy. In cases of chronic malaria or 

 malarial cachexia, in which this condition may appear, calcium 

 lactate in 10 grain doses should be given before each dose of quinine. 



3. SPECIFIC BLACKWATER FEVER. 



Synonyms. — Malarial Haemoglobinuric fever, Bilious Hsemoglobinuric 

 fever. Bilious Remittent fever. Malignant Bilious fever, Haemorrhagic Malarial 

 fever, Melanuric fever. French : Fievre Bilieuse Hematurique, Fievre Bilieuse 

 Hemoglobinurique, Fievre Bilieuse Grave, Fievre Bilieuse Melanurique, Fievre 

 Jaune des Creoles ou des Acclimates. Italian: Febbre emoglobinurica. 

 German : Gallenfieber, Schwarzwasserfieber. 



Definition. — Blackwater fever sensu stricto is an acute specific 

 fever of unknown causation, characterized by the severity of the 

 symptoms, great blood destruction, jaundice, and hsemoglobinuria. 



History. — ^The knowledge of this fever is recent, for it does not 

 appear to have been noted by Torti, the celebrated writer on per- 

 nicious fevers, nor by his predecessors, and the first information 

 of its existence appears to have been given by the French naval 

 surgeons Lebeau, Daulle, and Le Roy de Mericourt in 1850-53, 

 who drew attention to the disease in Madagascar and Nossi-Be, 

 after which it is mentioned as occurring in Senegal, Cayenne, and 



