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November 17, 1900


Author Affiliations


JAMA. 1900;XXXV(20):1257-1263. doi:10.1001/jama.1900.24620460007001c

We are accustomed to using this term—the principal symptom of the disease—because it overshadows all others. Under ordinary circumstances it makes the diagnosis, and the layman knows its import.

The synonyms are, black-water fever (Das Schwarzwasser Fieber), hematuria, hemoglobinuric fever, swamp fever, icterohematuric fever; fièvre bilieuse hématurique, first described by French naval surgeons stationed at Nossibe, a French settlement off the northwest coast of Madagascar.

The pathology and pathologic anatomy of malarial hemoglobinuria is in all essential particulars the same as—and in fact is—that of a malignant malaria, with the addition of hemoglobin in the urine and rapidly increasing jaundice. There is always a history of one or more paroxysms—chills and fever—with insufficient or no treatment.

A cachectic may have had no active manifestations of malaria for months, and after undue exposure or fatigue, have a violent hemoglobinuria and die in twenty-four hours. Usually, however, there are two, three or four,