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February 18, 1911


JAMA. 1911;LVI(7):514. doi:10.1001/jama.1911.02560070046021

Although it is generally accepted that blackwater fever —the acute febrile hemoglobinuria of tropical and subtropical regions—is malarial in origin, no means has as yet been found to demonstrate this with certainty; and not infrequently there appear enthusiastic advocates for its specific character. Such a one is Craig,1 who, in an able review, presents a strong case against the malarial hypothesis. This hypothesis is founded on the following evidence: first, the occurrence of the disease only in malarial districts, and its greatest frequency in localities infested with pernicious malaria; second, the presence of plasmodia in the blood either just before or during the attack; third, the fact that most, if not all, sufferers give a history of previous malarial attacks, and ordinarily have spent a long period in a malaria-infested region; and last, the fact that the blood-picture, a relative increase in large mononuclear cells, is that of malaria.