PROGNOSIS 



1225 



prevented and cured, and, moreover, is directly associated with a 

 dose of quinine. Malarial haemoglobinuria closely resembles black- 

 water fever, but is definitely associated with subtertian parasites as 

 a rule, and much more rarely with other forms of malarial parasites. 



Prognosis. — ^The mortality in our experience varies greatly, being 

 very high in some epidemics and low in others. The mortalities 

 given by Skelton are as follows: F. Plehn, 4 per cent.; A. Plehn, 

 6'8 per cent.; Stendel, 16 to 17 per cent.; Koch, 21 per cent.; 

 Berenger-Feraud, 23 to 24 per cent.; Schellong, 42 per cent.: 

 Reynolds, 50 per cent. 



Bad signs are: — 



1. Persistent vomiting. 



2. Hiccough. 



^. Profuse diarrhoea. 



4. High fever. 



5. Sudden decrease in the tension and mcrease 



in the frequency of the pulse. 



6. Diminutionor cessation of urine. 



7. Coma. 



Good signs are: — ■ 



1. Little gastro-intestinal disturbance. 



2. Low temperature. 



3. Good pulse. 



4. Clear mind. 



It is usually said that a person should not return to the tropics 

 after suffering from blackwater fever, but many people do return, 

 and appear to remain in excellent health. Of course, there is the 

 great risk of further attacks. 



Treatment. — ^This may be considered under the following: — 



1. During the attack. 



2. After the attack. 



3. Remarks. 



I. During the Attack. — The treatment during the attack 

 may be considered under the headings (a) Recommended Therapy, 

 (b) General Treatment, (c) Diet, (d) Symptomatic Treatment. 



Therapy Recommended. — ^We recommend the Sternberg-Hearsey 

 treatment in cases of true blackwater fever, as distinguished from 

 quinine haemoglobinuria and malarial hsemoglobinuria. 



This treatment consists in administering 



Liquor hydrargyd perchloridi .. .. 30 mini ins. 



Sodium bicarbonate .. .. .. to grains. 



Water . . . . . . . . . . to i ounce. 



every two to four hours during the first twenty-four hours, and then 

 every three hours until the urine clears. (For details as to the 

 Sternberg method see Chapter XLH.) 



