JiLACKVVATER  1''E\  EK.  CASK  Id. 
Male,  twenty-six  years  of  age.  Engineer.  European. 
Has  lived  in  Nyasaland  for  two  }'ears,  and  during  this  time  he  has 
had  a  considerable  amount  of  fever.  He  has  taken  vei)-  little  quinine 
during  the  last  tw'elvc  months.  About  three  weeks  ago  he  had  a 
severe  attack  of  fever  which  lasted  four  or  li\e  days.  A  few  da)-s 
later  he  was  lun  over  by  a  trolley,  and  has  been  conhncd  to  lied  more 
or  less  since.  He  ivas  unable  to  sleep  and  felt  very  ill.  Three  days 
ago  he  felt  particularly  unwell  and  had  a  sore  throat.  The  next  day 
his  temperature  w^as  102°  F.,  and  he  took  seven  and  a  half  grains  of 
quinine.  Yesterday  his  temperature  was  103“  F.,  and  he  took  another 
seven  and  a  half  grains  of  quinine. 
1st  day.  He  felt  better  this  morning  and  took  ten  grains  of 
quinine  and  was  able  to  get  up.  At  noon  he  had  five  grains  of 
quinine  and  took  a  short  walk.  At  4  p.m.  he  suddenly  felt  v'ery  ill. 
He  had  a  severe  rigor.  T.  105°  F.  At  5  p.m.  he  passed  blackwater. 
Elad  troublesome  vomiting  and  flatulency  all  night. 
2nd  day.  Vomiting  had  ceased  and  patient  felt  I  letter.  Spleen 
enlarged  and  easily  palpable,  extending  one  and  a  half  inches  below 
the  costal  margin. 
3rd  day.  Patient  was  better  to-day ;  the  urine  was  not  so  darkly 
coloured. 
4th  day.  About  noon  there  w'as  a  relapse.  T.  103°  F. 
5th  da}/.  Patient  admitted  to  hospital  this  evening.  Blackwater 
continued.  T.  103°  F. 
6th  day.  The  urine  was  amber  coloured  this  morning.  About 
noon  It  became  red  again,  but  cleared  up  in  the  afternoon.  There 
was  another  relapse  late  in  the  evening. 
/th  da}/.  The  urine  remained  coloured  all  day;  in  the  evening 
T.  103-6°  F. 
8th  day.  Urine  still  contained  haemoglobin.  Quinine  bihydro- 
chloride  was  given  in  solution  in  two  and  a  half  grain  doses  at  6  a.m. 
and  9  a.m.  T.ater  in  the  day  the  urine  became  amber  coloured. 
1'.  102-4° 
