Blackwater fever: divine retribution or genetic happenstance?

ply of tropical afflictions; and they too were bitten by malariabearing mosquitoes. But the native population, having lived with the menace of malaria for a hundred generations, had inherited a modest measure of resistance to the disease; not so with the white slavers, their soldiers, missionaries or adventurers seeking precious metals. The medical literature of 1830 carried an article by a French naval officer noting an allegedly new disease in East Africa. This illness began suddenly, with high fever, shaking chills, marked asthenia, rapid pulse, bilious vomiting, obvious jaundice, and, within days, a progressive darkening of the urine. This disease, called blackwater fever, was originally confused with yellow fever or some sort of morbidity affecting the liver. Certainly the jaundice, the bile-stained vomitus and the darkened urine collectively pointed toward a disease of the liver. Only belatedly was it recognized as a complication of malaria. As more and more of these cases were recognized in central Africa – and later, in India and China – it became apparent that the acute breakdown of red blood cells was the catastrophic event leading to free hemoglobin and fragmented red blood cells clogging the kidneys and discoloring the urine. And further, that this was not a new disease but rather a severe complication in a patient already burdened by the most serious form of falciparum malaria. Blackwater fever, strangely, was largely confined to Europeaners dwelling in malarial Africa, especially blonds from northern Europe. Was this divine retribution for the European rape of the African continent? Or was it the process of natural selection which had so altered the genetic profile of resident Africans to make them slightly more resistant to the secondary ravages of the malignant form of malaria? In 1942, just months after this nation’s entrance into a global war beyond our boundaries, the United States Army issued a lengthy bulletin describing the hazards of blackwater fever, ending with this sentence: “Recurrence of blackwater fever is common, especially in the tropics. Send patient to temperate zone if possible.”