Blackwater fever is shrouded in mystery, its study, from etiology to treatment, disclosing problems as yet unsolved.
It is generally conceded that the disease (if it may be so called) consists of a destruction of red blood cells so widespread that the liver, being powerless to transform the liberated hemoglobin into bile pigment, the greater part is excreted by the kidneys. This conversion into biliary coloring matter is the physiologic fate of free hemoglobin and, indeed, its pathologic destiny up to a certain limit—which, according to Ponfick's postulate, is the destruction of one-sixth of the entire number of red cells—beyond which hemoglobinuria ensues. This much seems to be rather unanimously accorded. The nature of the hemolysin is the missing link in the pathogenetic chain.
That the blood destruction and consequent hemoglobinuria are due directly to the malarial parasite is maintained by some. Geographic distribution favors the assumption of a close
DEADERICK WH. THE PATHOGENESIS OF HEMOGLOBINURIC FEVER.. JAMA. 1907;XLVIII(22):1856-1859. doi:10.1001/jama.1907.25220480034002h