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Blackwater  Fever.  Case  ii. 
Male,  thiriy-eig-hL  years  of  age.  Locomotive  inspector.  European. 
I'lrst  came  to  Nyasaland  nine  months  ago,  and  has  lived  chiefly  in 
Port  Herald  and  the  Lower  Shire  district.  Previous  to  coming  to 
Nyasaland  he  had  spent  five  years  in  Rhodesia.  During  the  last 
nine  months  he  has  had  a  good  deal  of  malaria  but  has  never 
previously  had  blackwater  fever.  He  has  very  rarely  taken  any 
quinine.  During  the  last  week  he  has  been  very  unwell,  and  two 
days  ago  he  took  ten  grains  of  quinine.  The  next  day  he  felt  no 
better,  but  took  no  more  quinine. 
1  St  day  of  present  illness.  At  9  a.m.  he  felt  very  ill  and  Look  ten 
grains  of  quinine.  At  10-15  a.m.  he  passed  porter-coloured  urine 
and  again  at  11-30  a.m.  T.  103°  F.  During  the  remainder  of  the 
day  patient  was  very  restless  vomited  several  times,  and  passed  no 
more  urine. 
2nd  day.  Slept  a  little  during  the  night  and  took  larg'c  quantities 
of  fluid  by  the  mouth.  At  to  a.m.  he  passed  a  little  urine, 
which  was  porter  coloured.  Vomited  several  times.  Skin  and 
conjunctivae  of  a  very  distinct  lemon  yellow  tint.  Spleen  easily 
palpable.  T.  i05°IL  At  5  p.m.  T.  101°  F. 
3rd  day.  Had  a  very  bad  night ;  passed  no  urine  during  the 
night.  Continued  to  take  large  quantities  of  fluid  by  the  mouth.  At 
3-30  p.m.  he  passed  10  c.cm.  of  dai'k  red  urine.  At  6  p.m.  the  skin  was 
very  sallow  and  the  conjunctivae  lemon-yellow.  T.  101°  F.  Vomiting 
and  hiccough  very  troublesome. 
4th  day.  Slept  very  little.  T.  100°  F.  Urine  amber  coloured. 
The  total  amount  of  urine  passed  during  the  day  was  48  c.cm. 
5th  day.  Condition  of  patient  was  unchanged.  Urine  amber 
coloured.  Temperature  normal.  The  total  amount  of  urine  passed 
during  the  day  was  92  c.cm. 
6th  day.  Total  amount  of  urine  passed  to-day  was  /3  c.cm. 
/th  day.  Vomiting  and  hiccough  continue.  Total  urine  passed 
during  day  was  93  c.cm. 
8th  day.  Patient  felt  better,  slept  well,  pulse  and  temperature 
normal,  and  the  vomiting  was  not  so  troublesome.  Amount  of  urine 
passed  during  day  was  85  c.cm. 
