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XIV] met with a case in England in which a severe attack, followed by a still more severe and prolonged relapse, was the first manifestation of a blackwater-fever infection which must have been acquired at least nine and a half months previously— the time that had elapsed since the patient left Africa.

Symptoms.— The onset of blackwater fever is usually sudden. A slight or, more generally, a very severe rigor is followed by intermitting, or remitting, or irregular fever with marked bilious symptoms. Earlier or later in the attack, usually during rigor, the patient becomes conscious of aching, perhaps severe, pain in the loins, in the region of the liver and spleen, and over the bladder; in exceptional instances these local pains are absent. In consequence of a somewhat urgent desire he passes water, when he is astonished to see that his urine has become very dark in colour, perhaps malaga - coloured or, possibly, almost black. The fever continues, though not necessarily very high. Very likely he suffers from epigastric pain and distress, bilious vomiting to an unusual extent, and, it may be, bilious diarrhœa; or he may be constipated. The pain in the loins and the liver-ache continue, and the urine becomes darker and darker. By and by the sufferer breaks into a profuse sweat and the fever gradually subsides. The urine, which hitherto may have been very abundant, or, perhaps, somewhat scanty, now flows freely; and, after passing through various paling shades, from dark brown to sherry red, becomes once more natural in appearance. Coincidently with the appearance of the dark colour in the urine, or even before this has been remarked, the skin and sclerse rapidly acquire a deep saffron-yellow tint. This icteric condition persists and even deepens during the progress of the fever, continuing for several days to be a striking feature in the symptoms. When the fever subsides the patient is conscious of a feeling of intense weakness from which he recovers but slowly. Fever, with or without rigor, may recur next day, or for several days; or it may cease; or it may be remittent, or almost continued in type.