Distribution of Tropical Diseases in Africa. 447 
various neuralgias connected with malaria, and finally 
malarial cachexia. 
To the causes of malaria, and its production being 
favoured by local circumstances, or prevented in some 
cases, I shall not now allude, preferring to deal with such 
matters later on, when speaking of the prevention and cure 
of the disease. 
Although, as before mentioned, the West African coast is 
called “the white man’s grave,” yet it is undoubtedly true 
that to a certain extent it is not malaria which causes, or 
perhaps one should say has caused, the very high death-rate 
of even 50 per cent. amongst the whites on the coast. In 
the past, at any rate, this death-rate has been due to the fact 
of diseased individuals proceeding to Africa, to want of 
knowledge of the precautions necessary for a residence there, 
and unfortunately, in many cases, to the wilful ignoring of 
prophylactic measures and of a well-ordered life. 
In Senegambia malarial fever causes at least 40 per cent. 
of all the cases of disease. In some places the admissions 
into hospital from malarial fever rise as high as 70 to 
80 per cent. The greater number of cases occurs during 
the rainy season, or between June and November, and 
chiefly, in all likelihood, at the commencement and at 
the end of the rains, and probably the pernicious and 
bilious and hematuric fevers happen chiefly during the 
rainy season, when the. mean monthly temperature is 
highest. With regard to the hematuric fever, it probably 
occurs only under certain circumstances, namely, in debili- 
tated individuals, after extreme strain or excess, or after a 
severe wetting following repeated attacks of ordinary 
intermittent fever. The bilious remittent fever may be 
considered as an acclimatising fever, occurring chiefly in 
newcomers. 
Next, in Sierra Leone the amount of malaria is extreme. 
The type of fever is here very severe, a very fatal remittent 
type being most commonly met with in the whites. Again 
we find that here also it is during the rainy season that 
malaria is most virulent. On the Gold Coast the same 
conditions exist, and grave remittent fevers, with bilious and 
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