55

CHAPTER IV.

SPECIFIC RELATION OF BLACK-WATER FEVER TO MALARIA.

     It is sometimes stated in recorded cases of Black–water Fever that the patient
had not previously suffered from malaria; this statement, if true, is evidently a strong
argument against Black-water Fever being the direct outcome of constant malarial
attacks. Our own experience has led us to doubt very much whether such histories
are trustworthy. For reasons already given we think it is very improbable that a
man could live for several years in any Black-water Fever country known to us
without contracting malaria; the ordinary European does not take precautions,
and infection with malaria is one of the conditions imposed by residence, which few,
if any, can escape, but which shows itself more prominently in some than in others.
This must be exceedingly clear to all who have experience of the countries in
question.

     But since the reasons on which we base this view do not seem to be generally
recognised it is desirable to emphasize them.

     There are three conditions tending to obscure the frequency of malarial
attacks in a highly malarious country—

          (1) Familiarity of the patient with attacks which cause him altogether to
                  ignore their importance.

          (2) Refusal under certain circumstances to acknowledge the disease.

          (3) Non-recognition.

     It frequently happens that when European residents in an intensely malarious
country are questioned as to whether they have suffered from malaria or have had
any recent attacks they give a denial to the direct question, but on more closely
cross-questioning them they admit a history of repeated " bilious attacks,"
" headaches," touches of the sun " or fits of retching, or dyspepsia.

     Without going into further detail we may say that, in our experience of mala–
rious countries, " biliousness," " retching " " vomiting," " headache," " touches of
the sun," and even " influenza " and " colds " are not necessarily "masked" malaria
but as a rule the symptoms of typical though more or less mild attacks of the disease.
In one case a medical man in Africa told one of us that he was feeling a " bit bilious";
on examination of his blood a considerable malignant tertian infection was found.

     We could, were it advisable, multiply such instances by the score; though such
a want of recognition we feel bound to state has not been a feature in the Duars
where several of the medical men use the microscope freely in diagnosis. We may,
however, refer to cases and histories which arc self-contradictory.