Post-mortcru  cxaunnation. — Body  well  nourished,  no  distinct 
yellowness  of  the  skin.  No  oedema  of  the  subcutaneous  tissues 
About  600  c.cm.  of  fluid  in  the  peritoneal  cavity.  The  spleen  was 
considerably  enlarged.  The  liver  was  enlarged  and  pale.  The 
kidneys  were  considerably  enlarged  and  congested  ;  capsules  slightly 
adherent;  cortex  swollen  but  otherwise  not  markedly  altered' 
i:)yrainids  very  dark,  exhibiting  a  striated  appearance  ;  the  pelvis  of 
the  kidney  normal  in  aspect.  The  heart  was  slightly  dilated;  no 
excess  of  fluid  in  the  pericardium  ;  heart  substance  natural  in  aspect; 
valves  of  heart  healthy.  Pleural  cavities  free  from  fluid.  Lungs  not 
congested  or  oedematous.  Mucous  membrane  of  stomach  and 
oesophagus  injected.  The  suprarenals  and  pancreas  presented  no 
change.  Bladder  healthy  in  aspect;  it  contained  about  10  c.cni.  of 
amber  coloured  urine. 
Microscopical  exaniinnlion. — The  kidneys  contained  numerous 
brownish  plugs  or  casts  within  the  uriniferous  and  collecting  tubules. 
These  plugs  were  made  up  of  coarse  granules  5//  to  in  diameter, 
arranged  singly  or  in  groups,  partially  filling  the  lumen  of  the  tubules 
and  fretpiently  accompanied  by  free  epithelial  cells  and  finely  granular 
or  flocculent  deposit.  Further  details  are  given  on  pp.  1O/-119, 
The  renal  tubules  were  dilated.  The  interstitial  tissue  presented  no 
change  in  aspect.  The  blood  vessels  contained  no  malarial  pigment 
The  liver  showed  slight  interlobular  cirrhosis,  but  no  fatty  change 
and  no  malarial  pigment.  No  malarial  parasites  or  pigment  were 
found  in  the  spleen. 
Black  WATER  Fever.  Case  12. 
Male,  thirty-four  years  of  age.  Fitter.  Indian. 
Has  been  in  Nyasaland  for  the  past  eleven,  months,  having 
previously  lived  some  time  in  Uganda.  During  the  last  six  months 
he  has  suffered  from  fever  two  or  three  times  every  month.  He  lias 
never  previously  had  blackwater  fever.  Does  not  habitually  take 
quinine,  but  occasionally  when  he  has  fever  he  takes  five  or  ten 
grains.  He  commenced  to  be  ill  yestorday,  and  took  five  grains  of 
quinine. 
1st  day.  Felt  no  better  this  morning.  y\t  noon  he  had  a  rigor, 
and  took  five  grains  of  quinine.  At  4-:|.5  passed  blackwater. 
