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     History.—Had suffered a good deal from malaria, having been obliged to go away for
over a month previous November. Had enlarged spleen. About beginning
of May began to get attacks of malaria, simulating acute gastritis. Vomiting
and retching occurred every second day. Fever so slight as to be overlooked
by patient. About middle of May went to another garden on a visit. While
there attacked with severe fever. Took much phenacetin and some quinine.

     Attack.—(1) Passed black and deep red urine for two days, and became somewhat
jaundiced. When a little better went for a trip, but while on the river had a
return of fever. Took grs. 20 of phenacetin, and suffered from collapse. Fever
continued. Blood examination showed small ring malarial parasites.

     Attack.—(2) Urine bloody in colour. Patient would not take quinine on account of
nausea and vomiting. Euchinin obtained and administered in grs. 10 doses
(30 grs. before noon each day, at which time temperature used to rise). Urine
cleared after two days, but fever continued longer, although parasites were not
found. Convalescence complicated with dysentery. Patient recovered and went
to England.

   Case XXXI.—Tezpur, Assam. Attack Black-water Fever October 1905.

     A. B. T., Tea-planter, aged 35, European.

                       Length of residence in Assam.—About 13 years.

                      Length of residence in Tezpur.—About 7 years.

     History.—Had suffered occasionally from severe malaria, once nearly dying from an
attack which may have been Black-water Fever. Went to England on leave
in 1903 and returned in the cold weather. Kept fairly fit during 1904, but got
attacks of fever and biliousness rather often during the rains of 1905. Had rather
a severe attack of fever towards the end of September, but did not remain from
work in consequence. Only took quinine when attacked with fever. Early in
October had a severe attack of fever, but still attempted to remain at work.
Bilious vomiting was a marked feature of this attack which was supposed to be
largely " liver." On October 6th took a purgative, and for the fever several
doses of phenacetin followed by quinine. That night had a rigor with vomiting
and passed dark urine. Got up next day, but vomiting (bilious) and fever
continued. Took more phenacetin and quinine. When seen was found to be
jaundiced, with a high temperature, a tender and enlarged spleen, and a tendency
to retch and vomit bilious matter. Temperature about 103. Blood examination
negative. Urine very dark reddish black, but in large amount. On boiling a deep
brown deposit came down half filling the test tube. After 48 hours the urine
commenced to clear the spleen rapidly reduced in size, and the jaundice largely
disappeared, but a marked bronzing of the skin remained and was still present
some months later.