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Case XXXII.—Tezpur, Assam. Attacked December 1905.

               A. B. H., Tea-planter, aged 25, European.

                    Length of residence in Assam.—7 years.

    History.—Came to Assam in 1898. Suffered very often from malaria. Had an en-
larged spleen for several years and on one occasion passed dark urine which how-
ever was not seen by others. In 1904 changed his bungalow, going to live in one
within a short distance of a populous coolie line. While here had attacks of fever
at frequent intervals. Used to take quinine very irregularly, 20 to 30 grs. one day
because of fever, and then no more for a few days until again feeling " seedy."
Had been suffering at intervals of about 10 to 14 days for several months before
Black-water Fever occurred. On several of these occasions blood examination
showed malignant tertian infection. Ten days before the Black-water Fever
patient had a typical attack of tertian fever (36 hours' fever, a remission of
12 hours and again fever). Malignant tertian parasites were present in the
blood. Quinine was taken as before, but was shortly afterwards stopped, owing
to its being " forgotten."

   Attack.—Day before attack had a return of fever, and took a dose of quinine and went
to work, and next day felt rather better. In the morning, however, took 20
grs. of quinine and went to work, but complained of feeling ill, and passed
highly coloured urine. In the evening was still at office work but felt cold, and
when seen was looking sallow and haggard. Advised to go to bed, but while
undressing had a rigor. About an hour after passed dark red urine. Temperature
rose but only to 99, slight nausea and bilious vomiting, with tenderness of
the spleen and pain at the pit of the stomach. Blood examination showed no
parasites. Urine on boiling showed a deposit of albumen half filling test-tube.
Next morning considerable jaundice observed. Great weakness present, patient
being unable to sit up or even to turn over without assistance. Towards the
evening the urine commenced to clear and by next day was apparently normal.
Temperature also came to normal very quickly, but the spleen remained
enlarged and tender for some time. Convalescence was fairly rapid, but was
marked by a great tendency to suffer from indigestion. Nine months after had
slight attack of jaundice, but no hæmoglobinuria.

   Case XXXIV.—

         Babu J. N. N., native shopkeeper, aged 25.

   Belongs to Burdwan in Bengal, but has resided in the Mateli bazaar for the past
   four years.

   History.—Has had a good deal of fever. Nine months ago was away in his country
for five months. Since his return has often had slight fever and twice severe
attacks.

   July 8.—Was feeling all right.

   July 9.—Had fever in the evening, but took no quinine.