PART I.

INTRODUCTORY.

Chapter I.

HISTORICAL AND GENERAL.

   Discussion of the ætiology and nature of Black-water Fever has occupied a
host of authors, and a minute study of all that has been written on the subject
would serve no useful purpose. It will be sufficient briefly to marshal all the known
facts; to indicate the different views that have been held as to the nature of Black-
water Fever; and to see what are the main issues now open for research.

   Broadly speaking four main theories have been held as to the nature and origin
of Black-water Fever; and around these different views can be grouped all the
recorded facts.

   These four theories are:—

I.

THAT BLACK-WATER FEVER IS A PERNICIOUS FORM OF, MALARIAL ATTACK.

   The early French observers (1) who first differentiated the disease from among
the other pernicious fevers, and determined that its characteristic sign is hæmo-
globinuria, not as had been previously thought the presence of blood or even
bile in the urine, considered as a result of their clinical observations and the
study of the distribution, that Black-water Fever is malarial in nature,
evidently regarding it as a particular form of pernicious access. The Ameri-
can writers (2), who shortly after described the disease in the United States, did
not even question the relation of Black-water Fever to malaria; but called the
condition "malarial hæmaturia." F. (3) and A. Plehn (4), who besides clinical ob-
servation made examinations of the blood for malarial parasites, also arrived at
the conclusion that. Black-water Fever is some form of malarial attack.

   A new phase in the study of the disease was introduced by the researches of
several physicians in Greece (5) and of Tomaselli (6) in Sicily, who recorded cases
of hæmoglobinuria closely resembling the hæmoglobinuric fever described by the
French and Americans from the tropics. In these researches the part played by
malaria is not emphasized, the point that is incontestably proven being the action

( 1 )

227 H. D.