The pulse is rapid, 110 to 120, from the first but soon becomes feeble and of low tension. In severe cases the very rapid almost thready pulse, with pallor and cold extremities, may resemble a severe haemorrhage. Epistaxis is not uncommon. A very unfavorable symptom seems to be hiccough. Another frequent cause of death and the one against which we chiefly direct our therapeutic measures is anuria with subsequent uraemic symptoms, such as coma and convulsions. At times a nephritis may develop in the course of a blackwater attack and the case subsequently run as one of severe nephritis.
Very striking is the rapidly developing anaemia, some cases showing a loss of two million red cells in twenty-four hours.
The mind is usually clear throughout an attack, the patient showing restlessness and marked anxiety.
In mild cases the fever course and haemoglobinuria is over within twenty-four hours leaving the patient far more prostrated than would a malarial paroxysm. In severe cases, however, the fever runs a remittent course over several days, with more marked haemoglobinuria and jaundice.
There may be cases which only show haemoglobinuria. These apyretic cases have been considered by some as quinine haemoglobinuria.
Symptoms in Detail
Fever Course.—This resembles that of a malarial paroxysm and may be intermittent in character or last several days as a remittent fever. The rigor which accompanies the febrile rise is intense.
The Liver and Spleen.—As a result of the marked blood destruction the liver is unable to dispose of the haemoglobin outpouring and icterus, which usually comes on in a few hours and is intense, is almost constant together with epigastric distress, bilious vomiting and tenderness and slight enlargement of the liver. The spleen is also somewhat enlarged and quite tender.
The Circulatory System.—At first the pulse is rapid with tension but soon it becomes weak, compressible and of low tension. In severe cases it may have a rate of 150 or more or even become thready.