MALARIAL PROPHYLAXIS -SEGREGATION 
2 33 
2. An accurate history of blackwater fever cases will always reveal that the 
patient has suffered more or less constantly from previous attacks of fever, and that 
for a day or two previous to his attack he has had a more or less markedly high 
temperature. That this temperature is of malarial origin is shown by microscopical 
evidence, for, 
3. If the blood of a patient about to suffer from blackwater fever is 
examined by chance before the onset of the disease, and before the taking of quinine, 
it is almost invariably the case that malarial parasites are easily found. An examination 
of the same case after the onset of the blackwater is, however, most frequently 
negative as regards parasites. Thus Panse,* in a recent paper, found parasites without 
exception in all those cases which he was able to examine immediately before the onset 
of the haemoglobinuria ; and arrives at exactly the same conclusion as ourselves as 
to the direct dependence of blackwater on malarial infection. 
4. That blackwater fever affects residents mainly in their second and third 
year suggests that it occurs in conditions of chronic malarial infection, and is strongly 
against a view which has been suggested that blackwater fever is due to a special 
parasite. Thus Berenger-Kerau d~|~ gives the following data : First year, 5.4 per 
cent. ; second year, 22*5 per cent. ; third year, 42*5 per cent. ; fourth year, 20 per 
cent. ; fifth year, 4-8 per cent. 
5. Again, the fact that, in West Africa and other regions where blackwater 
fever occurs, Europeans die not so much of malaria but of blackwater fever seems 
to admit only of one conclusion. To give more exact figures, it appears that in the 
German Colonial possessions, out of 3, coo cases of malaria, there were eight deaths 
only from ordinary malaria, but sixty-two from blackwater fever. However we con- 
sider these general points they all clearly point to the malarial origin of blackwater 
fever, though, as we have said, the real evidence depends upon the microscopical 
evidence of malaria in blackwater. 
Blackwater fever, then, is malarial in its nature, and its prophylaxis is con- 
sequently identical with that of malaria. 
* Zeitschrij't fur Hygiene, s. i, 1903 
"|" De la ficure bilieuse melanurique de% pays Chands. Paris, 187a 
F I 
