Clinically we have a prostrating chill of asthenic type associated with early jaundice and the passage of porter-colored urine—haemoglobinuria.
Synonyms.—Haemoglobinuric Fever, Bilious Haemoglobinuric Fever, Haemorrhagic Malarial Fever.
French: Fièvre Bilieuse Hemoglobinurique. German: Schwarzwasserfieber.
History and Geographical Distribution
History.—There is no reasonable doubt that the explanation of the fact that blackwater fever was first brought to the attention of the medical world, by Lebeau and other French naval surgeons, in Madagascar, in 1850-1853, was due to the confusion of this disease with the bilious remittent type of pernicious malaria as well as with yellow fever. Even after the clinical picture was well recognized, disputes as to the nature of the coloring matter of the characteristic urine were frequent, some considering that the dark color, which we now know to be due to haemoglobinuria, was due to haematuria or that the color was due to bile. Blackwater fever must have been the condition referred to in medical literature of the period, 1850 to 1870, under the names “Fièvre bilieuse haematurique,” “haemorrhagic malarial fever” and “febris remittens haemorrhagica.”
It was first described in the U. S. by Cummings of Louisiana in 1859. Other American physicians during the next ten years, described the disease from various other Southern states.
Veretas noted the presence of the disease in Greece, in 1858.
It is rather remarkable that the disease was not noted by so keen an observer as Torti, if it existed in his time, and Manson states that it is strange that it should not have been recognized in India if it had existed there prior to recent times. Some think that its introduction into Africa has been of recent occurrence. There are two explanations of the recent greater prominence of the disease in Africa and other tropical areas, where malignant malaria prevails extensively, which are (1) that there has been a great influx of susceptible Europeans into such areas during the past twenty or thirty years and (2) that the more frequent and excessive dosing of malarial patients with quinine is responsible.
