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disease, quinine and malaria

BLACK-WATER FEVER.A disease thought to be a severe type of malaria. It is observed in various bad malarial regions, but chiefly on the coast of tropical Africa; and it is characterised by fever, generally ushered in by a severe chill, serious constitutional symptoms, vomiting, jaundice, and a peculiar discoloration of the urine, due to the sudden destruction of a large number of red blood-cells. This last characteristic, being the most striking to the lay mind, has given the name to the disease. The urine may have a Bordeaux-red colour, or resemble coffee, porter, or Malaga wine, or may even become blackish-brown, owing to the copious admixture of the colouring-matter of the blood. The disease lasts from a few days to a number of weeks. It rapidly produces severe antenna and loss of strength, and often has a fatal outcome.

Black-water fever occurs as a rule in persons who have spent a con siderable period of time in a malarial region, and who have perhaps already passed through several attacks of malaria. It is rarely observed within the first six months of a sojourn. Among the incidental causes, quinine seems to

play an important role. The attack often follows immediately upon the use of the drug, at times even upon the taking of a very small dose. The quinoline derivatives, of which quinine is one, have the power of causing blood changes ; and it may be that the extra stress put on the blood by even small doses of quinine aids in the htemolysis. It is essential to summon a physician as soon as possible, a desideratum often difficult to fulfil in the tropical regions in which the fever is endemic. The patient must forego the use of quinine; and the suppression of urine. which ordinarily occurs in the disease. must be combated by the absorption of large amounts of fluids, especially mineral waters and milk. The prophylactic measures are identical with those for malaria. It may he that this disease is due to a micro organism allied to, yet distinct from, that of true malaria.

BLADDER.----For structure and functions, see URINARY ORGAYs in CHAPTERS (pp. 150-150.