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Report of an Attack of Blackwater Fever Subsequent to Induced Malaria¹

G. G. Sadler
Florida State Hospital, Chattahoochee, Fla.

The malarial background and clinical aspects of an attack of blackwater fever have been described; the episode occurred in a white female patient, age 37, subsequent to malaria therapy.

The patient had experienced an infection with one strain of each plasmodial species during the preceding 13 months; P. vivax had been allowed to disappear spontaneously, and P. malariae had been suppressed by a course of plasmochin; the falciparum infection, in spite of a course of quinine administered following the acute phase of the attack, persisted for five months, with minor parasitic and consequent clinical activity during the latter period of the infection.

Onset of the hemoglobinuric episode probably occurred within 12 hours of initiation of quinine medication; it was characterized by emesis and the rapid development of icterus; fever, unaccompanied by rigor, appeared about 11 hours after onset.

The attack lasted one week and was featured by: anemia, involving the loss of 70 to 75 per cent of circulating erythrocytes in the first 24 hours; moderate emesis, chiefly bilious early in the attack; daily fever in the afternoons (continuously at or above 100°F. for 48 hours on the third to fifth days), with rigor on the sixth and seventh days; hemoglobinemia, hemoglobinuria, and proteinuria during the first two days; bilirubinemia (10.2 mgm. per cent on the second day) and intense icterus which gradually decreased after the second day; a state of near collapse on the second day; edema on the fifth to seventh days; the absence of microscopically detectable parasites from the peripheral blood.

Treatment chiefly comprised blood transfusions, infusions of saline and glucose, moderate dosage of alkali by mouth, and supplementary oxygen.

¹ Presented before the joint session of the American Society of Tropical Medicine and the National Malaria Society, St. Louis, Mo., November 15, 1944.

The studies and observations on which this paper is based were conducted with the support and under the auspices of the International Health Division of The Rockefeller Foundation, in cooperation with the Florida State Board of Health and the Florida State Hospital.