BLACK WATER FEVER 
201 
Madagascar. 
Daulle observed blackwater here in 1 851-1854. Davidson 104 describes 
cases at Nossi-Be from 1862-1880, one hundred and eighty-five cases, forty-nine 
deaths. Dutrouleau, 105 Lebeau, 106 Quennec, 107 Barthelemy-Benoit, 108 and Yersin, 109 
also describe blackwater in Madagascar. 
Bourbon. 
Laveran, quoted by Marchiafava and Bignami," 4 says, 'the opinion that such 
a fever is produced by quinine is a popular belief among the Creoles of Reunion, but 
one which is not shared by their physicians, who have always protested against the 
prejudice,' whereupon Marchiafava and Bignami remark, ' but it seems that the 
prejudice was on the part of the physicians and that the laity were in the right'. 
Mauritius. 
Hirsch and others mention its occurrence here. Labonte discusses renal 
hemorrhage as a sequela of Mauritian fever. With regard to ' Mauritian tever ' and 
the part played by quinine in determining blackwater, it is interesting to note that 
de Valence" 5 writes that, 'in 1823, Joseph Conison said that sulphate of quinine 
should be tried in continuous fevers.' 
India. 
Hirsch quotes Day" 7 regarding the occurrence of blackwater fever in India, 
but it is very doubtful if Day's description refers to blackwater. Isolated cases have, 
from time to time, been recorded, especially from the Duars and Terai of Bengal, 
both notoriously malarial districts. Christophers and myself on visiting these 
districts found, to our surprise, as enquiry from Indian physicians had elicited, very 
little positive information on the subject, that in these districts (the tea gardens) 
blackwater fever was as common, and even commoner, than in tropical Africa. 
In India it occurs then in the Duars and Terai (Bengal), in Assam, and in 
the Jeypore agency (Madras), though it is not at all improbable that it exists 
elsewhere also.* Regarding the distribution of malaria in India, extra- 
ordinary variations in intensity are found even within the limits of ten to 
twenty miles. In both the blackwater regions of India visited by us the malarial 
intensity was very high. (The malarial intensity or endemic index of a district is 
measured by the percentage of children, under ten, infected with parasites). In 
these districts it varied between 70 per cent, to 100 per cent. It was also a note- 
worthy fact that in both these districts the species of parasite was almost exclusively 
quartan, whilst elsewhere simple tertian was the prevailing species. 
* Since writing the above Dr. Christy informs me that he has himself seen three cases in the Canara district (Bombay 
presidency). So that here, apparently, we have yet another focus in India. 
B I 
