SPECIFIC BLACKWATER FEVER 



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the Antilles. In 1858 Veratas described its occurrence in Greece, 

 and in 1859 Cummings met with it in America. 



The clinical signs were carefully described by Dutroulau in 1858 ; 

 by Corre in 1861, who showed that the colour of the urine was due 

 to haemoglobin, and not to bile or blood, as had been thought; 

 by Barthelemy and Benoit in 1865; Berenger-Feraud in 1874 

 (in which year Tomaselli first described it in Italy) ; Pellarin in 

 1876; and O'Neill in 1882. Kelsch and Kiener in 1889 gave an 

 excellent description, together with a history of the disease up to 

 that date. In 1890 Schilling met with it in Kaiser Wilhelm's Land, 

 and Grocco and Cardarelli in Italy, after which a series of papers by 

 Mahly, Easmon, Eyles, and Papafio appeared on the disease as 

 seen on the Gold Coast, where it is called ' attridi assara,' which 

 means ' bilious fever. ' The name ' blackwater fever, ' now universally 

 adopted, was, as far as we know, first used by Easmon. 



Researches have been made as to its nature and treatment by 

 Koch, Plehn, Crosse, Prout, Stephens, Christophers, Bentley, 

 Barratt, Yorke, Cardamatis, Leishman, Low and Wenyon, Balfour, 

 and others. 



With regard to the parasitic cstiology Macfie notes that in these cases the 

 cytoplasm of the malarial parasites is apt to stain badly, and therefore, as 

 they are difficult to see, they may often be missed. 



Laloir thinks that the peculiar organism which he has described as a 

 malarial parasite in the red corpuscles and nuclei of the mononuclears and in 

 the salivary glands of Anopheles listoni var. albo-apicalis may be a causal agent. 



With regard to chemical cstiology, I.ahille has shown that there is no defici- 

 ency of salts in the blood, and Burkitt has drawn attention to the high acidity 

 of the urine and the diminished alkalinity of the blood. 



As regards records Stephens has drawn up a valuable routine form, which, 

 modified in some particulars, has been utilized in the Sudan for some time. 



In regard to clinical features, under the term Icteroideta paludica Salvin has 

 described a sort of bilious remittent fever as a prehaemoglobinuric fever in 

 Venezuela, and Plehn has classified blackwater into: — 



1. Simple Attack. — Temperature falls to normal on the second to third 



day, and even albumen has disappeared from the urine by the third, 

 fourth or fifth day. The only danger is anuria on the third day. 



2. Intermittent Attacks. — The haemoglobinuria is intermittent, with very 



slight icterus, progressive anaemia, and death on fourth to fifth day. 

 Anuria is rare. 



3. Fulminating Type. — Very slight icterus, anuria, coma; death in twenty- 



four hours. 



4. Hcsmorrhagic Type. — This appears to us to be the haemorrhagic type 



of atypical subtertian fever. 



5. Abortive Ambulant Type. — This appears to us to be our quinine hsemo- 



globinuria, as it commences after a small prophylactic dose of 

 quinine. 



It seems to us that until tropical practitioners accustom themselves 

 to differentiate from specific blackwater fever the haemoglobinurias 

 due to quinine and to malaria no real progress will be made with 

 the knowledge of this serious illness. 



Climatology. — ^The disease occurs most commonly in tropical 

 Africa and in certain localities in India, but it has also been reported 

 from many parts of the tropics. 



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