^  Jlll^ 
226 
43*^0.  (iog'4°F.).  Patient’s  face  and  hands  became  deeply  ye|lo^v 
Died  at  5  p.m.  Not  seen  by  myself  till  1 1  p.m.,  when  the  urine  and 
vomit  had  been  thrown  away.  Face  and  hands  were  of  a  raarkedly 
brownish  yellow  colour.  Post-mortem  examination  not  permitted. 
Blackwater  Fever.  Case  14. 
Male,  thirty-nine  years  of  age.  Store  assistant.  Indian. 
lias  been  in  Nyasaland  for  five  years.  He  has  had  a  great  deal 
of  fever,  his  temperature  frequently  reaching  102°  or  103°  F.  About 
fifteen  months  ago  he  had  his  first  attack  of  blackwater  fever.  Has 
not  taken  quinine  regularly,  but  only  occasionally  when  ill. 
1st  day  of  illness,  bias  been  feeling  unwell  for  some  time,  but  only 
became  seriously  ill  to-day,  when  his  temperature  rose  to  100°  F.  He 
had  a  severe  headache,  took  ten  grains  of  quinine  sulphate,  and  went 
to  bed. 
2nd  day.  Condition  unchanged.  T.  99'S°  F.  Took  five  grains 
of  quinine.  In  the  evening  his  temperature  had  risen  to  101°  F.,  and 
he  had  another  five  grains  of  quinine.  At  10  p.m.  he  had  a  severe 
rigor.  T.  io5'4°F.  Shortly  afterwards  he  passed  porter  coloured 
urine.  Vomiting  was  very  troublesome. 
3rd  day.  Patient  had  another  severe  rigor  this  morning, 
T.  106°  F.  Severe  vomiting  all  day. 
4th  day.  Condition  unchanged  this  morning.  Skin  and  con- 
junctivae  of  a  lemon  yellow  colour,  spleen  just  palpable.  T.  I03‘’F, 
The  vomiting  was  still  severe,  but  the  urine  was  evidently  clearing  in 
the  evening. 
5th  day.  Patient  much  better,  urine  clear,  vomiting  less  trouble¬ 
some,  temperature  normal. 
Subsequently  the  patient’s  recovery  was  uninterrupted. 
Condition  of  blood. — 4th  clay.  At  5-30  p.m.  patient’s  oxalated 
plasma  was  of  a  reddish  colour  ;  it  gave  in  a  column  eighteen 
millimetres  high  distinct  bands  of  oxyhaemoglobin  and  methaemo- 
globin,  equalling  o‘57  per  cent,  of  haemoglobin  in  solution.  No 
malarial  parasites  or  pigmented  leucocytes  were  found  in  the  blood. 
5th  day.  At  10-45  a.m.  patient’s  oxalated  plasma  was  of  a  deep 
orange  colour  with  no  red  tint,  containing  o' 18  per  cent,  of  haemo-l 
globin.  Methaemoglobin  bands  were  also  distinct.  No  autolysiM 
