The disease was first linked to malaria by the Sierra Leone Creole physician John Farrell Easmon in his 1884 pamphlet entitled The Nature and Treatment of Blackwater Fever.
Within a few days of onset there are chills, with rigor, high fever, jaundice, vomiting, rapidly progressive anemia, and dark red or black urine.
[citation needed] The most probable explanation for blackwater fever is an autoimmune reaction apparently caused by the interaction of the malaria parasite and the use of quinine.
Blackwater fever is caused by heavy parasitization of red blood cells with Plasmodium falciparum.
[4] It may be that quinine plays a role in triggering the condition,[5] and this drug is no longer commonly used for malaria prophylaxis.