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Eight  years  ago  he  had  his  first  attack  of  blackwater  fever.  This 
attack  was  very  severe,  and  he  continued  to  pass  blackwater  for  five 
days.  The  next  two  years  he  suffered  from  a  good  deal  of  fever,  and 
had  three  more  attacks  of  blackwater  fever.  He  stated  that  after 
each  of  these  attacks  he  had  a  relapse.  During  the  next  six  years  he 
had  but  little  fever,  and  no  further  attack  of  blackwater  fever,  He 
used  to  take  about  twenty  grains  of  quinine  a  week  during  the  6rst 
five  years  he  spent  in  Nyasaland,  but  has  taken  hardly  any  for  the 
last  five  years. 
During  the  last  two  months  he  has  been  living  m  a  very  wet  camp,  j 
but  remained  comparatively  well  until  about  a  week  ago,  when  he  had  i 
a  severe  attack  of  fever.  This  passed  off,  but  was  followed  by  j 
another  two  days  later,  and  by  still  another  on  the  next  day.  He  j 
took  five  grams  of  quinine  on  the  third  day  of  his  illness  and  ten 
grains  on  the  fourth  day,  previously  not  having  taken  any  for  over  a 
year.  On  the  fifth  day  he  was  admitted  to  hospital,  and  given  five 
grains  of  quinine.  T.  ior6°F.  | 
6th  day.  Slept  badly,  perspired  freely  during  the  night.  Quinine 
bihydrochloride  in  solution  was  administered  in  five  gram  doses  at 
7  a.m.,  9  a.m.  and  noon.  At  2  p.m.  he  slept  for  an  hour,  but  awakened 
feeling  chilly.  At  3  p.m.  T.  101°  F.,  and  at  3-30  p.m.  he  passed  red 
urine.  At  6  p.m.  T.  104°  F.,  complained  of  pain  in  chest  and  legs. 
Had  a  good  deal  of  retching,  bringing  up  a  little  bile-stained  fluid, 
At  7  p.m.  T  100°  F.,  pulse  104.  Complained  of  flatulency,  skin  was 
of  a  very  distinct  lemon  yellow  tint.  Spleen  easily  palpable. 
7th  day.  Troubled  greatly  with  flatulency.  Vomiting  was  very 
troublesome.  At  6  a.m.  T.  gg°  F.,  pulse  78-  9  P  ™-  I00'2°F.| 
the  vomiting  was  less  troublesome. 
8th  day.  Patient  much  better.  T.  ioo°  F.  at  6  a.m. 
gth  day.  Felt  quite  well.  Skin  still  of  a  lemon  yellow  colour, 
spleen  enlarged  and  hard,  and  extended  three  fingers’  breadth  below  , 
costal  margin. 
Condition  of  blood. — 5th  day,  at  3-30  p.m.  Patient’s  oxalated 
plasma  was  of  a  dark  orange  colour  with  no  red  tint.  Oxyhaemo-  c 
globin  bands  were  faint,  the  blood  plasma  containing  O' 16  per  cent,  of  f 
oxyhaemoglobin.  No  autolysin  present.  A  few  malarial  parasites,  . 
but  no  pigmented  leucocytes,  were  found  in  the  blood. 
