ADDENDA. 
57 
been observed in West Africa, and especiall}- by railway engineers — who perhaps sufter more from fever 
than any other section of the white population. I was anxious to sec if this could be explained on the 
ground that the upturning of earth caused an increase of Anopheles puddles. When, therefore, the 
Governor, Sir William Macgregor, M.D., K.C.M.G., invited me to go by special train up the Lagos 
Railway from Abutemetta to Aro, I eagerly seized the opportunity. I found that the railway track was 
entirely a made track, and that to provide the soil for embankments, etc., many excavated pits had been 
made. In some places, for a mile or more these pits remained gaping at intervals of about twenty yards. 
In all that I examined there were puddles of varying depth and size, and without exception these puddles 
contained Anopheles larvx. This is, to my mind, a point of great interest and importance, and ma}' 
entirely explain why in West Africa, at any rate, railwa)- engineers and officials are peculiarly and pre- 
eminently exposed to malarial infection. 
Throughout the West Coast malaria is ever before 
men's eyes as an inevitable evil which all must suffer at some 
time or another ; and the result is that any rise of tempera- 
ture is immediately diagnosed as malaria, and rigorously 
treated with quinine. I saw at least one case in which a 
lady suffering from a typical attack of pneumonia (temp. 
104° F. ; dyspnoea, complete evidence of consolidation, etc.) 
was di.agnosed as malaria, was treated with quinine, and was 
going to the bad. Fortunately a medical man, comparatively- 
new to the coast, with a mind open and not befogged by 
coast tradition, was called in, and a correct diagnosis made : 
the lady recovered with a ty pical crisis. 
This is a glaring instance of the tendenc}- on the 
coast to diagnose any rise of temperature, be it heat insola- 
tion, pleurisy, rheumatism, or even constipation, as malaria. 
The absence of microscopes, and the apparent want of belief 
in the advantage of microscopical investigation, is responsible 
to a great extent for this state of affairs ; but traditional 
ideas born before the discoveries of Laveran still hold swa)-, 
and cannot wholly be exculpated. 
It is noteworthy that black-water fever occurs at all 
periods of the year; and, as far as I can judge, its curve 
of incidence bears no relation whatever to any of the three 
curves on the chart. Black-water fever occurs chiefly among 
two classes of the European community, viz. — 
(a) Roman Catholic priests and nuns. 
{b) German commercial community. 
Investigation shows that the connecting link between these 
two classes, and the fact that distinguishes them from other 
classes, is that they are the most overworked, the worst fed, 
and, as a general rule, obtain the least leave to Europe. Some never leave Lagos. 
I was informed that black-water fever is becoming more frequent in West Africa, but that its 
virulence is distinctly diminishing. As in the case of malaria, microscopical examinations of the blood 
in black-water fever is the exception rather than the rule, but I never met any medical man in West 
Africa who had been able to demonstrate blood-parasites in these cases. From a consideration of these 
facts I am inclined to think that black-water fever will one day prove to be a fever sui generis, and wholly 
unrelated to the malarial parasite. 
In Lagos, again, as in the Gold Coast, I venture to say that the disinterested activity of the English 
Schools of Tropical Medicine is bearing good fruit. Before I left I heard that 15 microscopes had been 
H 
RAINFALL, SUB-SOIL WATER AND FEVER 
AT LAGOS 
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i 89a 1899 
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