158
APPENDIX II.
Note upon Black-water Fever in Bombay.
Occasionally cases of Black-water fever are admitted to hospitals in Bombay; but in
the majority of instances the patients do not appear to have belonged to the City. During
the investigation however, two fatal cases of what appears to have been undoubted
Black-water fever were reported. In neither case was the disease returned as Hmo-
globinuria. Unfortunately neither of the cases was seen, but a few particulars were
obtained from the medical men who attended. One case occurred in the Frere Road and
the other in the North Fort, both of which areas are intensely malarious. Both cases were
children, one a Jewish boy aged 7 and the other a Parsi child. The Jewish boy had two
attacks, a second one only a month after the 1st. He had suffered from fever and had a
large spleen. During an attack of fever and after treatment with quinine he was suddenly
attacked with persistent bilious vomiting, had a rigor and passed reddish-black urine.
Next day he was seen to be intensely anaemic and jaundiced. He rallied rapidly but a
month later fever again occurred and during treatment with quinine a sudden return of the
former symptoms took place. This time he did not rally, but sank with symptoms of
heart failure. In the other case there was a similar history, but the patient died of
suppression of urine during the attack. In another fatal case of the disease which occurred
in hospital in 1910, all that could be learned was the fact that the patient was a European,
and had previously lived in Burma. No particulars could be obtained as to the length of
his stay in Bombay or his place of residence, A definite history of Black-water fever was
obtained from a European who lived at one time not far from Bombay in a small village
reputed to be very malarious. These facts are recorded, as they have a definite bearing
upon the relationship of Black-water fever to exposure to frequent infections by malaria.