BRITISH CENTRAL AFRICA 
180 
hours I had every symptom of black-water fever in a marked form. A case 
occurred with one of the ladies of the Universities Mission at Zanzibar who 
had an attack of black-water fever which came on after her return to England. 
The mortality in black-water fever is about 40 per cent, among those who 
have the disease for the first time ; 50 per cent, among those who have it for 
the second time ; 75 per cent, among those who have it for the third time; and 
it is very rare that anyone survives more than three attacks. Not counting the 
trifling little touch in the Tyrol, I have had four attacks of this disease at 
different periods from 1886 to 1896. I know one of the German officials in 
East Africa who has survived five attacks and is apparently in robust health, 
and Dr. Kerr Cross mentions an European in North Nyasa (in good health at 
the present time) who has had this fever ten times! 
On the last occasion when I had black-water fever I derived very great 
benefit from a single injection of morphia, which checked the vomiting and 
gave the body time for repose and recuperation. Otherwise I know of 
absolutely no drug which has been proved really efficacious in treating this 
dangerous disease. All we can say at the present time is that good nursing 
and a good constitution will generally pull patients through an attack. Quinine 
appears to be of little use, unless during convalescence. 
The symptoms of the disease are the following:— 
The patient ordinarily complains of a severe pain in his back and a general 
sense of malaise. This is often succeeded by a violent shivering fit. Upon 
passing urine the latter is found to be a dark sepia colour, and subsequently 
becomes a deep black with reddish reflexions, which accounts for the popular 
name given to the fever. Sometimes the colour is almost the tint of burgundy 
or claret. Not many hours after the attack has begun the colour of the 
patient’s skin becomes increasingly yellow. The temperature may sometimes 
be as high as 105 degrees following on the shivering fit, but high temperatures 
are not necessarily a very marked or serious symptom in black-water fever. A 
most distressing vomiting is perhaps the most customary symptom next to the 
black water. 
The best way to treat this fever is to put the patient immediately to bed, 
placing hot-water bottles at his feet, and to give him a strong purge. At first 
the vomiting should not be checked, but as soon as it tends to weaken the 
patient it ought to be stopped, if not by some opiate drug administered through 
the stomach, then by an injection of morphia. When it is deemed that the 
patient has vomited sufficiently to get rid of the poison in the system, and the 
further vomiting has been to some extent checked, nourishment should then 
be administered at frequent intervals—strong beef-tea, milk and brandy, eggs 
beaten up with port wine, &c. Champagne and water, especially if this drink 
can be iced and made into a champagne-cup, is excellent. Champagne is often 
of great use in this disease in restoring the patient’s strength. Once the 
dangerous crisis of the disease is passed and any relapse is guarded against 
by the most careful nursing, the patient is pretty sure to recover, unless he has 
naturally a very weak heart. The recovery is often pleasantly quick. In all 
my attacks of black-water fever there has rarely elapsed more than a week 
between the commencement of the disease and the power to get up and walk 
about, and convalescence in other ways has come rapidly. 
Undoubtedly much ill-health might be avoided in tropical Africa by the 
adoption of very temperate habits. I have written strongly on the drink 
question in such Reports to the Government as have been published ; I do not 
