107 
specific  gravity  was  somewhat  low,  being  1-015.  Unfortunately,  as 
in  the  preceding  cases,  no  estimation  of  the  output  of  urea  was 
possible.  1  he  coagulable  proteid  obtained  on  acidifying  and  boiling 
measured,  on  standing,  col.  Further  reference  will  be  made  to 
this  case  later. 
Attention  must  now  be  directed  to  the  condition  of  the  kidneys 
at  the  time  of  death  from  suppression  of  urine  in  Cases  7a  and  11. 
Before  proceeding  further,  however,  reference  may  be  made  to  the 
literature  of  this  subject.  The  number  of  post-mortem  records  of  the 
aspect  of  the  kidneys  in  suppression  of  urine  in  blackwater  fever, 
which  are  accompanied  by  a  report  of  the  microscopical  appearances 
of  these  organs,  is  ver)^  small.  Two  cases  of  death  with  suppression 
of  urine  in  blackwater  fever  are  described  by  H.  Werner,*  death  in 
one  case  (Case  i)  taking  place  on  the  day  of  the  attack,  and  in  the 
other  case  (Case  3)  on  the  third  day  after  the  commencement  of 
haemoglobinuria.  In  the  first  case  the  kidneys  were  dark  violet 
in  colour  and  were  not  markedly  enlarged.  The  medulla  showed  a 
dark  brown  striation  to  the  naked  eye.  On  microscopical  examina¬ 
tion  a  finely  granular  exudation  was  seen  within  the  Malpighian 
capsules,  and  occasionally  separated  epithelial  cells  were  noted,  but 
the  glomerular  cells  were  unaltered.  The  epithelium  of  the  convo¬ 
luted  and  straight  tubules  was  normal,  but  their  lumen  was  enlarged 
and  contained  coagulated  material  exhibiting  granules,  which  were 
fine  near  the  glomerulus  but  became  progressively  coarser  as  the 
collecting  tubules  were  approached.  No  trace  of  an  inflammatory 
process  in  the  connective  tissue  of  the  kidney  was  observed.  Inside 
the  blood  vessels  was  seen  black  malarial  pigment,  and  in  some 
places  plasmodial  division  forms.  In  the  second  case  described  by 
Werner  the  kidneys  were  of  a  pale  brown  to  yellowish  red  colour, 
and  were  enlarged.  The  microscopical  appearances  were  the  same 
as  in  the  first  case,  e.xcept  that  the  epithelium  of  the  convoluted 
tubules  .showed  in  places  cloudy  swelling. 
The  cases  coming  under  our  own  observation  were  two  in  number 
(Cases  ya  and  1 1,  Tables  41  and  42  ;  clinical  histories,  pj).  195  to  201 
and  pp.  217  to  222),  death  occurring,  as  already  mentioned,  on  the 
tenth  and  ninth  days  respectively,  the  duration  of  suppression  being 
*  XJber  die  Nieren  beim  Schwarzwasserfieber,  Arch.  f.  Schiffs-  und  Tropen- 
hygiene,  1907,  B.  ii,  S.  5. 
