^39 
together  with  epitlielial  cells  and  flocculenl  debris  ;  further  details  are 
given  on  pp.  1 19-123.  The  lumen  of  the  uriniferous  tubules  was  wide, 
but  did  not  exhibit  the  marked  distension  seen  in  the  kidneys  of 
Case  7a.  The  interstitial  tissue  was  free  from  haemorrhage,  and 
showed  no  cell  infiltration  or  increase  of  connective  tissue.  No 
cirrhosis  or  fatty  degeneration  of  the  liver  or  malarial  pigment  m  its 
vessels.  No  malarial  parasites  or  pigment  was  found  in  the  spleen. 
Blackvvater  Fever.  Case  17. 
Male,  thirty-two  years  of  age.  Planter.  European. 
Has  lived  in  Nyasaland  for  ten  years,  during  which  time  he  has 
had  one  or  two  attacks  of  fever  every  wet  season.  In  the  course  of 
the  last  eight  years  he  has  had  four  attacks  of  blackwater  fever.  He 
only  occasionally  takes  quinine.  He  suffered  from  an  attack  of  fever 
four  days  ago.  T.  I05°F.  Took  twenty  grains  of  quinine.  He 
remained  ill  for  the  next  three  days,  and  had  fifteen  grains  of  quinine 
each  day. 
1st  day.  Was  still  ill,  and  took  ten  grains  of  quinine  in  the 
morning.  During  the  evening  he  noticed  that  he  was  passing  black- 
water.  He  was  brought  into  hospital  the  same  evening.  His 
condition  was  one  of  considerable  exhaustion,  with  troublesome 
vomiting.  Spleen  slightly  enlarged,  and  just  palpable.  T.  101°  F. 
2nd  day.  His  condition  to-day  was  unchanged,  and  the  vomiting 
continued  all  day.  T.  105°  F.  This  rise  in  temperature  was 
accompanied  by  a  very  severe  rigor.  The  urine  was  porter  coloured. 
3rd  day.  The  patient  was  rather  better  this  morning  and  the 
temperature  almost  normal.  The  urine  was  still  highly  coloured. 
4th  day.  The  urine  became  decidedly  lighter  towards  evening. 
5th  day.  Patient  feels  quite  well.  Urine  almost  clear. 
6th  day.  The  urine  was  amber  coloured.  Patient’s  subsequent 
recovery  was  uninterrupted. 
Condition  of  blood. — ist  day.  At  11-30  p.m.  patient’s  oxalated 
plasma  was  of  a  deep  orange  colour,  with  a  distinct  red  tint, 
containing  o’65  per  cent,  of  haemoglobin  in  solution.  No  malarial 
parasites  and  no  pigmented  leucocytes  were  found  in  the  blood 
