Spleen puncture findings in blackwater fever

Abstract

A series of spleen punctures has been carried out in cases of blackwater fever, and the following observations made:— 1. (1) That there is little or no evidence of heavy malaria infection just prior to the onset of the blackwater fever, in the great majority of cases. 2. (2) That if the presence of pigment in the spleen may be taken as evidence of recent schizogony, then very few cases of blackwater fever can be said to be suffering from active malaria at the time of the onset of their haemoglobinuria. 3. (3) That the absence of pigment in the spleen may either mean that active schizogony was not going on, or that the organism possesses very variable ability to dispose of pigment rapidly. 4. (4) That in some patients vast amounts of pigment can be found for very long periods after the initial attack of blackwater, whilst in others none or only the barest traces can be found after the lapse of only a few hours from the first passage of black urine. 5. (5) That the rate at which the spleen disposes of pigment is an extremely variable factor, not dependent upon the time or amount of quinine taken prior to the onset of the blackwater. 6. (6) That the reticulo-endothelial system would appear to play an important role in this pigment destruction rate. 7. (7) That the correlation coefficient between the last dose of quinine and the first passage of black urine is so significant (0·87) as to make it appear that there is no means an essential pre-requisite, since blackwater does occur after atebrin, etc. 8. (8) That there is little difference between peripheral blood examination and spleen puncture so far as parasites are concerned; the latter is a little superior so far as pigment is concerned. 9. (9) That patients who have been in hospital and have taken a full treatment for malaria with either atebrin or quinine, sometimes go down without any warning with blackwater fever, their bloods and spleens being negative for both parasites and pigment.