CHAPTER XIV
BLACKWATER FEVER
Synonyms.— Hæmoglobinuric fever, melanuric fever, hæmaturic fever.
Definition.— An acute disease characterized by pyrexia— generally ushered in by severe rigor, bilious vomiting, icterus, hæmoglobinuria and, frequently, diminution or suppression of urine.
For a long time this disease, like kala-azar and several other tropical fevers, has been regarded as a form of malaria, and in earlier editions of this manual, in deference to general opinion, I described it, with some reservation, under that head. I have long entertained the idea that too much has been taken for granted in relegating black water to malaria, and thereby ignoring its possible individuality as a separate disease; an individuality strongly suggested not only by the symptomatology, but also by epidemiology and analogy. I have therefore now placed it by itself pending definite settlement of one of the most important problems still unsolved in tropical pathology. Such an arrangement, apart from other and more purely theoretical considerations, has its practical advantages.
Geographical distribution.— The geographical distribution of blackwater fever is very wide. Although it does not coincide with that of any of the known types of malaria, and although the endemicity of blackwater fever is not coextensive with that of malaria, it is only in localities in which malaria is very prevalent that blackwater fever can be acquired. Endemic concurrence, however, must not be looked on as conclusive of identity; the germ causes of very different diseases may have certain topographical requirements in common.
The prevalence of blackwater fever in various
