Blackwater  Fever.  Case  2. 
Male  about  forty  years  of  age.  Planter.  European. 
Has  been  in  Nyasaland  for  thirteen  years.  His  first  attack  of 
blackwater  fever  occurred  eight  years  ago  ;  was  ill  with  ‘  fever  ’  for 
a  fortnight,  then  took  forty  grains  of  quinine,  after  which  blackwater 
appeared.  Since  then  has  had  several  attacks  of  malaria,  but  lias  not 
suffered  again  from  blackwater  fever.  Has  passed  small  amounts  of 
pus  in  his  urine  for  last  twelve  months,  and  occasionally  has  passed 
bright  blood  at  the  end  of  micturition. 
Eight  days  ago  was  drenched,  and  could  not  change  his  clothing 
for  some  hours.  Yesterday  took  five  grains  of  quinine,  had  to  pass  a 
catheter,  being  unable  to  void  urine  naturally. 
To-day  (first  day)  temperature  became  raised ;  patient  suffers 
from  vomiting  and  diarrhoea,  and  is  very  restless.  Has  painful 
cramps  in  muscles  of  legs.  Took  five  grains  of  quinine. 
2nd  day.  Still  restless  but  somewhat  improved  in  morning.  Al 
10  a.m.  had  six  grains  of  quinine  bihydrochloride  hypodermically,  his  _ 
temperature  being  then  98'4°  F.  At  11-15  a.m.  again  restless,  |  ^ 
temperature  I03’5°  F.,  vomited.  At  12-0  mid-day  passed  150  c.cm.  of 
very  dark  chocolate-coloured  urine.  Pulse  now  very  feeble  and  ” 
rapid;  shivering;  extremities  cold.  At  12-30  p.m.,  temperature  , 
105°  F.;  at  1-30  p.m.,  temperature  101°  F.  Then  commenced  to  1” 
perspire  freely,  and  condition  improved.  Spleen  projects  about  3|in.  ,. 
below  costal  margin.  Liver  cannot  be  felt.  Heart  and  lungs  normal  Tc 
3rd  day.  Condition  much  improved.  Skin  has  become  sallow. 
Urine  contained  chocolate-coloured  deposit  until  mid-day,  when  this  " 
disappeared  and  dark  amber  urine  was  passed.  „ 
Subsequently  patient’s  condition  steadily  improved.  The  urine 
continued  free  from  haemoglobin,  no  relapse  occurring.  Pus  in  urine 
continued  as  before. 
Condition  of  blood. — On  the  ist  day,  before  blackwater  appeared, 
an  examination  of  patient’s  blood  was  made  at  4  p.m.  The  blood 
plasma  was  of  a  dark  orange  colour  with  a  slight  greenish  tirrt,  and 
gave,  in  a  column  18  mm.  high,  excessively  faint  oxyhaemoglobin  1 
bands,  the  amount  of  dissolved  haemoglobin  being  about  O' 13  percent 
No  isolysin  was  present.  No  malarial  parasites  could  be  found  m 
blood  smear. 
