200 THOMPSON YATES AND JOHNSTON LABORATORIES REPORT 
Gold Coast and Gaboon. 
M. Losedat, priest, had observed, since I 846, many times that malarial fever 
was accompanied by intense bilious phenomena, icterus, and black urine (p. 34 100 ). 
The frequency on the West Coast of Africa is given on p. 241 IC0 as — 
Gaboon and Gold Coast - 3%-5 c stacks annually 
Upper Senegal - - 20 ., ., 
Southern Rivers - - 1 5 ,, ,, 
Cayor - 8 „ „ 
St. Louis and Goree - - 1-3 ,, „ 
That blackwater fever is common along the West Coast of Africa is a matter 
of common knowledge, but it is difficult to say where it is most frequent. One 
factor alone would make any estimation of the kind difficult, it is the very unequal 
distribution of a European population. Without Europeans there is practically no 
blackwater (its very rare, if genuine, occurrence among natives would, in no way, 
appreciably affect the statistics). Now, it is equally notorious that in the West 
Coast of Africa we have as regards its malaria one of, if not the most, deadly places 
in the world for Europeans. And this correspondence 111 the distribution of malaria 
and blackwater fever is not denied, of course, by those who deny their correspondence 
elsewhere. But I may be permitted to diverge so far from my intention not to base 
arguments as to their identity on the correspondence in distribution of blackwater 
fever and malaria, as to point out some striking facts with regard to the mortality 
from 'malaria' in tropical Africa. 1 examined the statistics of deaths in all German 
colonies in Africa for a number of years, and got these remarkable figures : — 
Total deaths — 
JDeaths from 
Deaths from 
European and native 
Malaria 
Blackwater fever 
294.8 
8 
62 
Surely the conclusion that in these ' deadly fever-stricken regions ' malaria 
has a comparatively small mortality is not the true one, but, on the contrary, the 
obvious one that blackwater fever is in fact malarial. 
To resume the question of distribution, blackwater fever then is well-known 
along the West Coast of Africa, in Nigeria, in the Cameroons, in the Congo, probably 
Portuguese West Africa ; but whether as far south as Damaraland, I am unable to 
say. On the east coast it extends as far south as Beira and Delagoa Bay. British 
Central Africa, Uganda, German East Africa, British East Africa ; in all these it 
occurs. Cases will be found recorded in English periodicals. A consideration of 
Madagascar, Mauritius, the Comoro islands, may be interesting. 
