174 
IX.  CLINICAL  RECORDS. 
Before  giving  the  clinical  records  of  the  patients  coming  under 
observation,  a  few  words  may  be  said,  by  way  of  introduction, 
concerning  the  general  features  presented  by  the  attacks  of  black- 
water  fever  from  which  they  suffered.  For  convenience  of  reference,  a 
synopsis  is  given  in  Table  52,  p.  248.  The  observations  have  already 
been  for  the  most  part  collected  in  tabular  form,  as  indicated  below. 
Some  of  the  particulars  supplied  to  us  by  the  patients,  for  example, 
the  statements  made  as  to  past  attacks  of  malaria,  it  was  not  in  our 
power  to  verify. 
The  records  are  of  necessity  more  or  less  incomplete.  In  some 
cases  delay  occurred  in  reaching  the  patient,  either  because 
information  could  not  be  sent  to  us  sufficiently  early,  or,  more 
frequently,  because  of  the  slowness  of  travelling,  especially  during  the 
rainy  season.  The  simultaneous  occurrence  of  two  or  more  cases  at 
considerable  distance  apart  caused  difficulty  also  on  more  than  one 
occasion. 
The  number  of  attacks  of  blackwater  fever  investigated  was 
twentyc  These  occurred  in  seventeen  different  individuals,  all  males, 
eleven  being  white  men,  four  Indians,  one  Eurasian  and  one  Chinese. 
Only  one  attack  occurred  in  a  female  during  our  stay  in  Nyasaland; 
this  was,  however,  not  brought  under  our  observation. 
For  convenience  of  reference  and  comparison  dates  are  omitted, 
and  the  course  of  the  attacks  is  described  under  the  headings  1st  day, 
2nd  day,  etc.  (cp.  Table  50,  p.  247).  One  attack  occurred  in  January 
six  in  February',  four  in  April,  one  in  May,  two  in  June,  three  in 
September,  two  in  October  and  one  in  December.  The  rainy  season 
extends  from  November  to  March. 
All  the  patients,  except  Case  5,  stated  that  they  had  suffered  from 
malaria  some  time  before  the  attack  (cp.  Table  49,  p.  161).  In  all 
except  four  (Cases  1,4,  13  and  14)  of  the  attacks  the  patients  were 
regarded  as  suffering  from  malaria  before  the  appearance  of  black- 
water.  Malarial  parasites  were  found  in  the  peripheral  blood  on  only 
one  occasion  (Case  3),  as  is  indicated  in  Table  46  (p.  151). 
In  all  the  twenty  attacks  investigated  quinine  had  been  taken 
before  the  onset  of  haemoglobinuria,  of  which  it  appeared  to  be  a 
