i 9 4 THOMPSON YATES AND JOHNSTON LABORATORIES REPORT 
to a less extent. Much of the American literature has been inaccessible to me, yet from 
those references I have collected, it appears that not only is blackwater known in 
most of the Southern States, but that it is, at least in certain districts, quite a common 
disease. Thus Hare s found that fifty out of one hundred and fifty-four practitioners 
in those areas of the census which had a mortality of seventy (or over) per thousand 
other deaths see it frequently. Of these, Alabama provides four, Georgia nine, 
Mississipi fourteen, Texas twenty-seven. He mentions that Cochrane, M.O.H., 
Alabama, collected six hundred and forty-two cases from different practitioners, with 
one hundred and fifty-eight deaths, or a mortality of twenty-five per cent. Bat 
Smith 6 says it occurs in the interior of Louisiana, and in Alabama, dating from 1867, 
and in Texas. He also says it occurs in Central America and Brazil. Field 7 
describes it in Virginia, where it is called Roanoke yellow fever, to distinguish it 
from yellow fever. Kilpatrick 8 says the real cause is undoubtedly malaria, and in 
Georgia is confined strictly to the white race. Roup 9 says the disease, malarial 
hematuria, is quite common in the swamp districts of this State (Arkansas). Bush 10 
says the disease is getting to be a very common occurrence in Florida, Georgia, and 
the Mississipi bottoms. 
In the report of the Tri-State Medical Association of Mississipi, Arkansas, 
Tennessee," the following conclusions are arrived at : — 
1 . Coloured race not entirely exempt, among fifty-seven cases five in 
coloured persons. 
2. Forty-one in males, sixteen in females. 
3. Fifty-one cases occurred in persons who had been subject to malarial 
attacks for a greater or less time. 
4. In thirty-six cases quinine had been given before the attack. In 
only one case had quinine not been given. 
These instances, out of many, will suffice to shew that in the Southern States 
of America blackwater fever is a well-known, and apparently a common, disease. 
Numerous other instances will be found in the bibliography appended. We have 
then reference to its occurrence in the following eleven States, viz., Virginia, North 
Carolina, South Carolina, Georgia, Florida, Alabama, Tennessee (?), Mississippi, 
Arkansas, Louisiana, Texas. 
Let us next consider the distribution of malaria in the United States, and for 
this purpose I have used the data of the 1890 census. The figures represent the 
number of deaths from malaria per i,cco other deaths. If we arrange the States in 
tie order of their highest mortality, we get the following series (column 1) : In the 
second, third, and fourth columns are given the values for other sections of each State, 
irom which it will be seen how variable is the mortality even in the same State, e.g., 
Georgia has in its southernmost part a mortality of seventy-four, in the northern 
part of only eighteen. Column 5 represents the occurrence of blackwater fever. 
