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VI.  THE  CONDITION  OF  THE  KIDNEYS  IN 
BLACKWATER  FEVER. 
The  condition  of  the  kidneys  during  the  haenioglobinuria  of  blad(- 
water  fever  is  of  necessity  a  matter  of  inference,  for  a  simple 
uncomplicated  attack  is  not  in  itself  fatal.  When  death  takes  place 
during  blackwater  fever,  this  is  due  to  some  complication,  such  as 
hyperpyrexia  (Case  13),  suppression  of  urine  (Cases  ya  and  11),  or 
severe  constitutional  disturbance  ending  in  cardiac  failure  (Case  16), 
and  it  may  happen  that  haemoglobinuria  has  ceased  some  time  before 
death.  In  these  cases  it  is  necessary  to  attempt  to  separate  such 
pathological  conditions  as  are  purely  representative  of  the  haemo- 
glcbinuria  from  secondary  or  associated  pathological  conditions.  The 
post-mortem  appearance  of  the  kidneys  of  animals  in  which  experi¬ 
mental  haemoglobinuria,  together  with  severe  blood  changes,  had 
been  produced  has  already  been  referred  to  on  p.  128,  and  our  own 
experiments  of  a  similar  but  simpler  character,  unattended  with 
general  constitutional  disturbance,  have  been  described  on  pp.  124-12; 
(figs.  45-51  und  59-60).  It  will  therefore  not  be  necessary  to  refer 
further  to  the  appearances  presented  by  the  kidneys  in  these  experi¬ 
mental  conditions,  but  reference  must  be  made  to  the  results  of  post¬ 
mortem  examination  in  cases  of  blackwater  fever,  omitting,  however, 
any  additional  description  of  the  kidney  changes  in  suppression  of 
urine  following  upon  blackwater  fever  (pp.  107-124;  figs.  33-40  and 
53-56). 
In  1882  Kiener  and  Kelsch*  in  an  article  on  ‘Nephrite 
paludeenne,’  observed  in  Algeria,  described  as  an  early  stage  of  this 
disease  ‘  congestion  hernaturique  ou  hemoglobinurique,’  in  which  the 
urine  contained  sometimes  dissolved  haemoglobin  together  with  brown 
granular  casts  and  debris,  in  addition  to  hyaline  casts,  leucocytes  and 
red  cells,  sometimes  only  red  cells,  but  no  dissolved  haemoglobin. 
On  section  of  the  kidneys  similar  casts  were  found  in  the  uriniferous 
tubules  (loc.  cit.,  p.  285-O  ;  also  Plate  VI,  figs.  8-14).  The  condition  in 
question  w'ould  now  be  called  blackwater  fever.  Further  investiga¬ 
tions  on  the  histology  of  the  kidneys  m  blackwater  fever  were  made 
■*  Les  alterations  paludeennes  des  reins.  .Arch,  der  Physiologfe,  18S2,  T.  li 
p.  27S. 
k 
