205 
J^LACKWATER  KeVER.  CaSE  Q. 
Male,  thirty-eight  years  of  age.  Contractor.  European. 
Has  been  in  the  7'ropics  for  fifteen  years.  Has  had  d3'senlery 
twice,  the  last  attack  two  years  ago.  Has  had  ‘  fever  ’  (malaria)  man)- 
times.  Has  siiftered  from  rheumatic  pains.  Has  not  had  lilackwater 
fe\er  before  present  attack. 
Has  not  been  feeling  well  for  some  weeks.  Apjietite  has  been 
poor.  Has  been  inclined  to  doze  in  daytime.  For  the  last  three 
weeks  has  had  ‘fever,’  for  which  he  has  been  taking  a  Durban  patent 
‘  cure.’  His  urine  has  been  of  a  dark  brownish  colour  for  last  six 
weeks.  Yesterday  took  nine  grains  of  quinine  in  tabloid  form. 
1st  day.  f  hinks  he  passed  blackwater  in  the  morning  wlicn  at 
stool,  but  regarded  the  colour  of  his  urine  as  due  to  bile.  Took  nine 
grains  of  quinine  during  the  day.  Stayed  indoors  and  had  a  rigor  at 
mid-day,  when  he  passed  more  blackwater,  which  he  still  regarded  as 
due  to  bile.  At  6  p.m.  his  urine  was  porter  coloured,  about  tyo  c.cm. 
being  passed.  Temperature  at  this  time  104-2  F. 
2nd  day.  Constitutional  disturbance  continues.  Urine  still 
remains  porter  coloured.  Vomited  about  twenty  times  during  evening 
and  night. 
jrd  day.  l.h'ine  still  red.  Lighter  coloured  in  evening. 
4th  day.  Urine  at  first  red,  later  became  amber  coloured. 
5th  clay.  During  the  2nd,  3rd,  4th  and  5th  days  only  about 
Ooo  c.c.  of  urine  was  passed,  together  with  a  small  but  inconsiderable 
amount  in  the  stools,  and  suppression  of  urine  was  feared.  Cardiac 
action  feeble. 
6th  day.  Passing  urine  more  freely. 
/th  day.  Continues  to  pass  urine  freely.  Is  ver}-  pale  and 
anaemic,  but  not  wasted.  Not  sallow.  Pulse  hard  and  sharp,  of  high 
tension.  Cardiac  dulness  abolished.  Apex  beat  cannot  be  felt,  but  the 
first  sound  is  at  a  maximum  three  and  a  half  inches  from  midsternal 
line  and  about  half  an  inch  inside  the  nipple  line.  No  adventitious 
