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Blackwater Fever

Published online by Cambridge University Press:  15 May 2009

Leonard S. Dudgeon
Leonard S. Dudgeon
Affiliation:
Professor of Pathology in the University of London.
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The chief facts learnt from these investigations on blackwater fever are summarised briefly here in the order in which they are detailed in the sections.

1. True jaundice, due to the presence of bile pigment in the plasma, occurred in a high percentage of the cases which ended fatally. Haemoglobinaemia, varying from a deep red coloration of the plasma to a faint tinging, occurred in the acute stages of the disease. There was no evidence of auto-agglutination or auto-haemolysis. The fragility of the red cells was unaltered. No relationship between syphilis and blackwater fever was obtained. Spirochaetes were not demonstrated in the blood in any instance. In the hundred cases in this series, a malarial history was obtained in every instance, and without exception the infection was contracted in the Balkans during 1915–1918. The only blood parasites found were Plasmodium vivax and Plasmodium falciparum.

2. The most important tissue changes were as follows: Fatty degeneration of the myocardium. Reduction of the fat lipoid content of the adrenal gland. Enlargement of the Malpighian corpuscles of the spleen due to various changes in the endothelial centres. Recent or chronic perisplenitis was present in every instance. The other changes in the spleen were numerous and variable and due to blood destruction and malaria. Haemorrhages in the liver tissue and foci of central necrosis, in which reactionary changes had occurred, were met with in many instances. Inspissation of the bile in the gall bladder and bile passages was of common occurrence.

The changes in the kidneys during the acute stages of blackwater fever were very pronounced, but complete recovery rapidly ensued during the period of convalescence without subsequent nephritis as far as the information available indicated. Spirochaetes were not found in any of the tissues in this disease. Scattered haemorrhages occurred in the most rapidly fatal cases.

3. From alcoholic and acetone extracts of the dried residue of the urine, obtained during the period of haemoglobinuria, haemolytic substances were demonstrated. From alcoholic and acetone extracts of the dried organs very active haemolytic substances were obtained, more especially from the acetone extracts.

The alcoholic extracts of the urine were more potent than the acetone in the three cases which recovered. Similar results were not obtained by extracting the dried viscera from cases other than blackwater fever, including malaria.

4. There was no evidence that quinine administered by any method during an attack of blackwater fever increased the severity or influenced the progress of the disease apart from its eftects on malaria. Quinine administered to animals rendered anaemic did not excite haemoglobinaemia. Quinine was obtained from the urine by extraction, during the period of haemoglobinuria, in amounts which corresponded to those obtained in the malarial cases. Rabbits injected with quinine previous to and during the period when both ureters were ligatured failed to develop haemoglobinaemia or haemoglobinuria.

5. The urine in cases of blackwater fever rapidly returns to the normal from the period of haemoglobinuria. Clumps of red cells which possess certain characteristics were found in the urine in some cases. Clumps of red cells were of common occurrence in the tubules of the kidneys. The injection of sterilised urine from cases of blackwater fever obtained during the period of haemoglobinuria failed to produce any ill eftects in animals.

6. Blackwater fever was most frequently met with during the months of March and April, at the time when the temperature was at the commencement of its upward summer rise. No evidence was obtained that blackwater fever is in any way related to anaphylaxis. It was not possible to employ any method to demonstrate whether blackwater fever is due to a filter passer.

Type
Research Article
Information
Journal of Hygiene , Volume 19 , Issue 2 , October 1920 , pp. 208 - 244
Copyright
Copyright © Cambridge University Press 1920

References

Arkwright, J. A. and Lepper, E. K. (18. i. 1918). A series of 16 cases of Blackwater Fever occurring in the Eastern Mediterranean. Trans. Soc. Trop. Med. and Hyg. XI. 127.CrossRefGoogle Scholar
Akmand-Delille, , Paisseau, S. and Lemaire, E. (28. vi. 1917). Note sur les caractères de la bilieuse hèmaglobinurique observée chez les paludéens de 1'Armée d'Orient. Bull. et Mém. Soc. Méd. des Hôpit. de Paris, XLI 773.Google Scholar
Barratt, J. O. W. and Yorke, W. (1909). An investigation into Blackwater Fever. Ann. Trop. Med. and Parasitol. III. 1.CrossRefGoogle Scholar
Bijon, R. (x. 1915). Etude expérimentale chez l'homme de l'influence de la quinine dans la pathogénie de la fièvre bilieuse hémoglobinurique. Bull. Soc. Pathol. Exot. VIII. 597.Google Scholar
Burkitt, R. W. (20. xi. 1915). Blackwater Fever. Lancet, II. 1138.CrossRefGoogle Scholar
Burkitt, R. W. (20. iv. 1919). The Treatment of Blackwater by intravenous injections of gum arabic… Pamphlet circulated by Consultant. in Malaria. War Office.Google Scholar
Dudgeon, L. S. (1906). A Study of the various changes which occur in the tissues in acute diphtheritic toxaemia. Brain, XXIX. 227.CrossRefGoogle Scholar
Dudgeon, L. S. (i. 1918). Certain observations on action of Bile and Bile Salts with and without the addition of the salts of calcium on animal red blood corpuscles. Journ. of Hygiene, XVI. 240.Google Scholar
Dudgeon, L. S. (xi. 1919). On the effects of injections of quinine into the tissues of Man and Animals. Journ. of Hygiene, XVIII. 317.CrossRefGoogle Scholar
Dudgeon, L. S. and Clarke, C. (vii. 1919). An investigation on Fatal Cases of Pernicious Malaria caused by Plasmodium falciparum in Macedonia. Quart. Journ. of Med. XII. 372.CrossRefGoogle Scholar
Fiessiner, N. (1918). Compt. Rend. Soc. de Biol. Paris, LXXXI. 38–40.Google Scholar
Fletcher, W. (1913). Report on Blackwater Fever. Federated Malay States. 13th Annual Report of the Institute for Medical Research, Kuala Lumpur, 1913.Google Scholar
Hannemann, K. (1918 a). München. med. Wochenschr. LXV. 615–619.Google Scholar
Hannemann, K. (1918 b). München. med. Wochenschr. LXV. 665–669.Google Scholar
Hartmann, H. and Zila, L. (1918). The Fate of Quinine in the Organism. Arch. Exper. Pathol. and Pharmacology, LXXXIII. 221.CrossRefGoogle Scholar
Hatori, J. (i. 1915). Blackwater Fever in Formosa. Ann. Trop. Med. and Parasitol. VIII. 641.CrossRefGoogle Scholar
Hunter, W. (1901). Pernicious Anaemia. London: Griffin and Co.Google ScholarPubMed
Hunter, W. (1908). “Jaundice”; “Diseases of the Liver” in Allbutt and Rolleston's. System of Medicine, IV Part 1.Google Scholar
Maclean, H. (1918). Lecithin and Allied Substances. The Lipins. Monographs on Biochemistry. Edited by Plimmer, and Hopkins, . London: Longmans.Google Scholar
Matko, J. (17. i.–14. ii. 1918). Ueber Wechselbeziehungen zwischen Harn und Chinin in der Hämolyse. Wien. klin. Wochenschr. XXXI. 65, 130, 188.Google Scholar
Muir, R. and Dunn, J. S. (1915 a). The retention of iron in the organs in haemolytic anaemia. Journ. of Pathol. and Bacteriol. XIX. 417.CrossRefGoogle Scholar
Muir, R. and Dunn, J. S. (1915 b). The absorption of iron from the organs after haemolysis. Journ. of Pathol. and Bacteriol. XX. 41.CrossRefGoogle Scholar
Muir, R. and Dunn, J. S. and Monee, J. W. (1912). The anaemia produced by a haemolytic serum. Journ. of Pathol. and Bacteriol. XVI. 410.Google Scholar
Napier, A. H. (x. 1913). Is Syphilis a factor in Blackwater Fever?. Indian Med. Gaz. XLVIII. 389.Google Scholar
Nierenstein, M. (iii. 1919). Haemoquinic acid—a new disintegration product of quinine, present in the urine especially in “Blackwater” Fever. Journ. Roy. Army Med. Corps, XXXII. 215.Google Scholar
Paisseau, and Lemaire, (1916). Bull. Acad. de Méd. de Paris, LXXVI. 300.Google Scholar
Phear, A. G. (1920). Some clinical notes on Blackwater Fever in Macedonia. Journ. Roy. Army Med. Corps, XXXIV. 1.Google Scholar
Plehn, A. (9. vii. 1914). Ein Beitrag zur Kenntnis der akuten hamolytisohen Malaria. Deutsche med. Wochenschr. XL. 1414.CrossRefGoogle Scholar
Porak, R. (31. v. 1918). Billeuse hémoglobinurique paludéenne et auto-anaphylaxie. Bull. et Mém. Soc. Méd. des Hôpit. di Paris, XLII. 559.Google Scholar
DrRaadt, O. L. E. (v. 1917). Die Komplementogene Wirkung von Chinin im Zusammenhange mit dem Entstehen des Sehwarzwasserfieberanfalles. Archiv f. Schiffs- u. Tropen Hyg. XXI. 149.Google Scholar
Seyfarth, (1918). Die Komplementogene Wirkung von Chinin im Zusammenhange mit dem Entstehen des Sehwarzwasserfieberanfalles. Archiv f. Schiffs- u. Tropen Hyg. XXII. 128–145.Google Scholar
Stannus, H. S. (iv. 1913). The Etiology of Blackwater Fever. Trans. Soc. Trop. Med. and Hyg. VI. 181.CrossRefGoogle Scholar
Stephens, J. W. W. (1907). See Allbutt's System of Medicine, II. Part 2, p. 289.Google Scholar
Stephens, J. W. W. (1913). Studies in Blackwater Fever. Ann. Trop. Med. and Parasitol. VII. 479.CrossRefGoogle Scholar
Yorke, W. (1911). Passage of Haemoglobinaemia through the kidneys. Ann. Trop. Med. and Parasitol. V. 401.CrossRefGoogle Scholar