3°7 
A CASE OF BLACK WAFER FEVER 
FOLLOWED BY A PECULIAR RELAPSE 
WITHOUT HAE M OGLOBIN U RIA 
OR DETECTABLE PLASMODIA 
BY 
Major R. ROSS, F.R.S., D. THOMSON, M.B., Ch.B., D.P.H., 
AND 
G. C. E. SIMPSON, B.A., B.Sc., F.R.C.S. 
(.Received for publication 15 November, 1910) 
This case was studied under the conditions and by the methods 
referred to in the previous paper, and is, we believe, the first 
case of blackwater fever which has occurred while daily estimations 
of the numbers of Plasmodia were being made by thick film methods. 
Though there is much evidence to connect blackwater fever with 
malaria, yet many authors doubt whether the typical fever generally 
associated with the haemoglobinuria is due entirely or at all to the 
parasites of malaria. Our case is of special interest because it 
throws considerable light on this question. It will be seen from the 
chart that the case had three separate pyrexial periods while under 
observation ; that the first of these was an ordinary malarial attack ; 
the second an ordinary blackwater attack (without detectable 
parasites); and the third a singular attack during which neither 
blackwater nor parasites were found—strongly suggesting, if not 
proving, that the later attacks were due to some cause other than the 
toxin of the Plasmodia, and that haemoglobinuria may be merely 
an occasional result of this unknown cause. A fourth attack occurred 
still later but, unfortunately, could not be studied by us. 
The patient, A. E. B., male, aged 32, an English trader on the 
bold Coast since 1903, stated that he had slight fever during his 
first year in West Africa, and numerous slight or severe attacks 
since then, but without any observed blackwater fever. He did not 
take much quinine until more recently, when (in February, 1910) he 
" as S' ven 3° grains daily for a fortnight, without its producing 
blackwater. He was admitted to the Royal Southern Plospital, 
