Annual report on the Medical Research Institute / 1909-.

  • Nigeria. Medical Research Institute.
Date:
[1923]
Catalogue details

Licence: Public Domain Mark

Credit: Annual report on the Medical Research Institute / 1909-. Source: Wellcome Collection.

    3/34
    y for the year 1923. BLACKWATER FEVER, Blackwater fever, or Haemoglobinuric fever has been the subject of much controversy with regard to its causation. As experience has grown and careful observations and records have accumulated, the balance of evidence has swung more and more definitely to the malarial origin of the disease. Nevertheless, from time to time, new theories arise and other parasites are described as of pathogenic importance. Blackwater fever has one sign common to all cases, that is the passing of urine which is coloured some shade of red or brown according to the amount of blood-colouring matter it contains and dependent on the time at which the urine is voided after having reached the bladder. But the sequence of events, the nature of the onset, the number and the severity of the general signs and symptoms, the course of the disease, all these vary within fairly wide limits in different cases, in West Africa, at any rate. That these are dependent on individual idiosyncrasy and are influenced by the amount and degree of previous malarial infection, actacks, moreover, for the most part inefficiently treated, is probably the correct view, but this very lack of uniformity has led many observers to seek for other explanations. One of the most recent papers on the subject, contributed by Dr. Lefrou and Dr. Blanchard, describes the finding of spiroehaetes in the blood of several cases of blackwater fever, which occurred in French Congo. These observers, by using the method of triple centri¬ fugation of the blood, isolated Leptospira from the third deposit, which they were successful in transferring to guinea-pigs. During the year under review, an opportunity was afforded at Yaba of examining four cases of the disease by this method. Three of :hese occurred in Lagos (one was probably a simple haemoglobinuria) and one hi Abeokuta. The technique consists in withdrawing a certain quantity of the patient’s blood from a vein, into a measured amount of a solution of Citrate of Sodium of a definite strength, in a tube. The mixture is then centrifugalised, the rate and the time being controlled. The first sediment which consists mainlv of red and white c/ cells is discarded. The supernatant fluid is again centrifugalised during which the remainder of the red cells and most of the blood-platelets are brought down. The second deposit is afso thrown away, and the fluid is centrifugalised a third time. The deposit, on this occasion contains some blood-platelets and any spirocliaetes which may be present. In all the four cases investigated by this method, structures were readily found which by the dark-ground illumination of wet films closely resembled spirochaetes. The deposit in each case was submitted to <'J her tests, smears were fixed and stained by Giemsa’s process and also by Fontana’s preparation, cultures were made and guinea-pigs were inoculated. The staining methods failed to reveal spirochsetes, the attempts at cultivation in artificial media were negative, and although spirochsete-like structures were seen in the blood of the inoculated guinea-pigs, the animals themselves, with one exception showed no ill-effects. In the first case of blackwater fever five series of sub- inoculations were carried out from guinea-pig to guinea-pig, a similar number in the second and third cases, and four series in the last case. In the second case, one guinea-pig in the third series of sub-inoculations, showed a blood-serum stained distinctly pink after centrifugalisation. This however, was almost certainly due to artificial laking. The failure to demonstrate spirochaetes except by dark-ground illumination directed attention to the examination of the blood, in health and in disease both in human beings and in laboratory animals.