APPENDICES 
■85 
bleeding from the mucous membrane of the stomach and bowels, which, acted on by 
the digestive fluids, may lead to a Black Vomit. A marked feature, too, in some cases 
is that the attacks are paroxysmal. They come on with a shivering fit, with pains in the 
back, retention of the testes, vomiting, and lowered temperature. Two hours afterwards, 
when the urine is passed, it is bloody, contains albumin, and deposits a thick sediment. 
The dark urine may continue to be passed for three or four days, but in other cases after 
a few hours there is a return to the normal state. I have known of seizures to come on 
every morning about eight o’clock for ten or twelve days in succession. Gradually, how¬ 
ever, they seemed to diminish in severity, and then to pass off. Between the attacks the 
urine seemed perfectly normal. 
There is another form where we get actual blood in the urine. The blood is 
intimately mixed with the urine, and is like “porter.” 
Then we may get actual suppression of urine. The malarial poison acts on the 
kidneys like a poison. The result of this suppression is uraemic poisoning. 
It seems to be the case that certain constitutions have a predisposition to this form of 
fever. There are many who have resided in British Central Africa for ten or more years 
who have not once suffered from its effects, while others have not been resident as many 
months, and have suffered from several attacks. It is not the case that quinine taken in 
prophylactic doses every day arms the constitution against it. For myself personally I take 
this drug only when I think I need it, and not as a preventative medicine; and while I 
have suffered from ordinary fever I have not once in eleven years had the more serious 
affection. This also seems to be an accepted fact: one attack of black-water fever 
predisposes to another, so that eventually every attack of malarial fever will take this 
form. I think this explains the fact of one European at the north of Lake Nyasa having 
had ten consecutive attacks in a period of three years. 
From the suddenness of its onset and the equal suddenness of its disappearance, 
together with its remarkable tendency in some cases to come on in paroxysms, I think 
that the explanation is to be found in the study of the neurotic supply of the kidney. 
It is remarkable, too, that women and weakly persons are seldom affected. It seems 
to be confined to young, healthy individuals, in whom there is great muscular waste. It 
comes on, too, after a long spell of the most robust health, and that with great sudden¬ 
ness. I think, too, that it is a disease of mountainous regions. It does occur in the 
lower parts, but my observation leads me to affirm that it is more prevalent in hilly 
districts in the centre of malarious regions. 
APPENDIX II. 
HINTS AS TO OUTFIT FOR BRITISH CENTRAL AFRICA 
1. Flannel is a great mistake unless it is mixed with a large proportion of silk. Pure 
flannel is an abomination in the tropics. Either on account of some inherent property of 
the wool, or probably of some chemical compound with which it is prepared, the action 
of perspiration on the flannel in a tropical country is to at once create a most offensive 
smell, even in persons who are constantly changing their clothes, and who attend to 
personal cleanliness. Moreover, no flannel yet invented (all advertisements on the 
subject are to be absolutely disbelieved) ever failed to shrink into unwearableness after, 
at most, the third washing. Again, the feel of the flannel on the skin in a warm climate 
is singularly irritating and hurtful. Persons going to Africa are strongly advised to 
wear not flannel, but either silk and wool underclothing, or merino. Merino is excellent. 
It is cleanly, absolutely odourless, stands any amount of washing, and is pleasant in 
contact with the skin. Under almost all circumstances save those where the temperature 
rises above 100 degrees in the shade, a merino under-garment should always be worn 
