BLACKWATER FEVER 
217 
III, THE COMPARATIVE MORTALITY OF MALARIA AND 
BLACKWATER FEVER IN TROPICAL AFRICA 
DR. CHRISTOPHERS and myself, while investigating the nature of blackwater 
fever, were much struck by the fact that in those intensely malarious parts of 
Africa visited by us, we did not encounter a single case of death from malaria, 
pet se y but deaths occurred always from blackwater fever. The evidence that con- 
vinced us that blackwater fever is malarial, was, however, based entirely on micro- 
scopical evidence, and those who wish to know what the evidence really is may be 
referred to our reports quoted above. While maintaining then that the direct 
evidence of its malarial nature, even in the absence of parasites at the time when 
the cases are most frequently examined, is conclusive ; it is not, 1 think, useless 
to consider evidence of a secondary nature. This evidence, too, is important, as 
it affords a mass of facts surely of much greater value than the many plausible 
suggestions made by those who have had no actual experience of the disease. To 
turn to the facts under consideration, it is not often that it is possible to give any 
numerical comparison of the frequency and fatality of malaria and blackwater fever 
respectively in a district. The following data I have compiled from the statistics 
furnished with regard to German colonial possessions in the ' Arbeiten aus dem 
kaiserlichen gesundheitsamte ' for the various years. Frequently the data are 
insufficient to afford the necessary comparison, but the following examples are 
sufficiently instructive to merit compilation here. 
In these statistics I have omitted the data (a few in number) with regard 
to native malaria, and the rare occurrence of blackwater among the native troops, 
because it is clearly absurd to consider European and native malaria as a whole and 
deduce any argument therefrom — the two conditions are so unlike. It must further 
be noticed that the number of cases under the heading blackwater cases may not 
be quite accurate, as in the reports it is only the deaths that are especially noted. 
However, this deficiency does not concern our present object. Further, under the 
heading malaria deaths,, it is possible that some of these are due to blackwater, for 
it is not always clear whether the distinction has been drawn or not. 
We have then, the following striking figures: — 
Cases of 
Deaths from 
Cases of 
Deaths from 
Malaria 
Malaria 
Blackwater Fever 
Blackwater Fever 
G. E. Africa, April, 1897, to March, 1898 
3 1 2 
O 
30 
2 
G. E. Africa, April, 1898, to March, 1899 
345 
> (?; 
33 
3 
G. E. Africa, April, 1899, to March, 1900 
39° 
0 
17 
8 (or ? 1 1 ) 
213 
0 
10 
1 
Cameroon, July, 1897, to June, 1898 
,- 138 
1 
1 2 
2 
Cameroon, July, 1899, to June, 1900 
U9 
+ 
1 2 
7 
Cameroon, July, 1900, to June, 1901 
186 
0 
28 
8 
Togo, 1899 to 1900 
72 
2 
5 
5 
1805 
8 (- ? 7) 
H7 
36 (? 39) 
D I 
