170 
VII.  ICTERUS  AND  BLACKWATER  FEVER. 
The  statement  is  frequently  made  that  icterus  occurs  in  blackwater 
fever.  This  word,  while  in  its  strict  sense  designating  true  jaundice 
due  to  the  presence  of  bile  pigment  in  the  blood  plasma  and  urine,  is 
also  sometimes  employed  loosely  to  indicate  merely  a  yellowish 
tinting  of  the  skin  and  sclerotic  coat  of  the  eyeball,  not  necessarily 
due  to  bile  colouring  matter.  The  use  of  the  term  icterus  in  describing 
this  latter  condition  in  blackwater  fever,  without  any  statement  as  to 
whether  the  urine  contains  bile  ]iigment  or  not,  is  frequent  and  is 
apt  to  be  misunderstood.  The  same  indefiniteness  of  meaning  is  also 
apparent  in  the  description  of  experimental  work  in  which  haemo- 
globimiria  has  been  induced.  It  would  appear,  however,  that  true 
jaundice,  dependent  upon  bile,  pigment,  is  producible  together  with 
haemoglobinuria  by  toluylendiamin,*  though  so  far  as  we  know  no 
other  drug  is  capable  of  producing  these  two  conditions  simul¬ 
taneously.  It  is  asserted  by  Kocht  that  after  the  administration  of 
quinine,  instead  of  blackwater  fever,  an  atta,ck  of  icterus  may  result, 
haemoglobin  being  converted  into  bile  pigment,  which  appears  in  the 
urine. 
In  the  cases  of  blackwater  fever  which  came  under  our  notice,  as 
also  in  cases  of  malaria,  the  urine  was  not  unfrequently  high  coloured 
(brownish  amber)  after  the  attack.  When  the  urine  obtained  during 
the  haemoglobinuria  of  blackwater  fever  was  acidified  and  boiled,  the 
liquid  obtained  on  filtration  was  usually  of  a  light  amber  colour, 
though  sometimes  remaining  of  a  somewhat  brownish  tint.  On 
testing  the  filtrate  for  bile  pigment  .with  iodine  a  negative  result  was 
obtained.  In  the  same  way  a  negative  result  was  obtained  in  the 
experimental  haemoglobinuria  of  rabbits.  In  consequence  of  the 
absence  of  bile  pigment  in  the  urine  it  follows  that  the  dark  amber  or 
orange  colouring  matter,  obviously  derived  from  the  breaking  up  of 
haemoglobin,  which  the  blood  plasma  often  presents  in  blackwater 
fever  and  for  some  time  subsequently,  and  sometimes  also  in  malaria 
(Table  33,  p.  73)  is  not  due  to  bile  pigment. 
*  G.  Joannovicz,  Kxperimentelle  Uiitersuchungen  fiber  Ikterus,  Zeitschr.  f. 
Heilkuiide,  1904,  Bd.  25.  .S.  25.  M.  Afannassiew,  tlber  die  patliologisct 
anatomiscben  Veranderungen  in  den  Nieren  und  in  der  Leber  bei  einigen  ml 
llamoglobinurie  oder  Ictenis  verbundeneii  Vergiftungen,  Virch.  Arch.,  1884,  I'll’ 
qS,  S.  460. 
f  Uber  Schwarz.wasserlieber  (llamoglobinurie)  Zeitschr.  f.  Hygiene,  rSyS,  Bii. 
30,  S.  295.  Cp.  pp.  321-322  and  Case  3,  p.  303. 
