attended  with  any  pathological  condition  of  the  renal  epithelium,  the 
only  visible  change  ordinarily  present  being  the  appearance  of  brown 
granular  material  in  the  renal  tubules.  Whether  brown  granular 
material  is  also  of  necessity  present  in  the  epithelium  of  the  renal 
tubules  during  blackwater  is  uncertain. 
It  IS  moreover  clear  from  our  observations  that  an  attack  of 
haemoglobinuria  does  not  necessarily  damage  the  kidneys.  No 
albuminuria  of  renal  origin  followed  the  attacks  of  blackwater  fever 
coming  under  our  observation,  in  which  recovery  occurred,  and 
judging  from  the  cases  recorded  in  the  literature  of  this  subject, 
blackwater  fever  is  not  a  cause  of  nephritis. 
Before  concluding  this  section  reference  may  be  made  to  the 
circumstance  that  venereal  disease  does  not  seem  to  predispose  to 
blackwater  fever  nor  to  influence  its  course  when  present.  Particulars 
on  this  point  were  obtained  in  sixteen  cases  of  blackwater  fever,  with 
the  result  shown  in  Table  51.  On  further  comparison  of  the  cases  in 
'I'AiiLF,  51.  Blackw.iter  fever  and  venereal  disease. 
No,  of  Cases 
Syphilis 
Gonorrhoea 
9 
Absent 
Present  in  j  cases 
7 
Present 
Present  in  3  cases 
which  one  or  both  forms  of  venereal  disease  were  present  with  those 
in  which  a  negative  history  was  obtained,  it  is  found  that  the  severity 
and  duration  of  the  blackwater  fever  were  not  obviously  greater  in 
the  former  than  in  the  latter. 
SUMMARY 
1.  During  simple  uncomplicated  haemoglobinuria  of  blackwater 
fever  the  sole  pathological  condition  existing  in  the  kidneys  would 
appear  to  be  the  presence  of  brown  granular  material  m  the  lumen 
of  the  renal  tubules. 
2.  Venereal  disease  does  not  appear  to  influence  either  the 
tendenc)'  to  blackwater  fever  or  its  severity  when  present. 
