( 4 ) 
The Malarial Cases . — I have pointed out in Chapter VI., when dealing with 
the prevalence of malaria in British Honduras, that this disease was abnormally 
prevalent in 1904, not only in Belize, but also in Corosal and Orange Walk ; 
further that the type of the disease was very severe, that there was one fatal 
case of blackwater, that the disease assumed an intense epidemic form in certain 
localities, and that it went under the name “ Railway Fever ” on the Puerto 
Barrios Railroad. In 1905, however, the deaths from malaria do not appear to 
be abnormal. 
In January, 1905, two deaths occurred from remittent malaria in subjects 
aged 22 and 45 respectively, and one death from intermittent malaria in a baby 
of 1^ months ; in February one remittent case in a man of 37 ; in March one 
remittent case in a woman of 32, and in April two remittent cases, one in a 
man of 70, the other in a man of 30. On May 14th, the death occurred of 
Miss Bills from what was registered at the time as “bilious fever and 
hsematemisis,” but which there is now no doubt was Yellow fever. Later, in 
May, and in June, July and August, further deaths occurred from what was 
chiefly described as malignant malaria, or remittent malaria ; some of these 
there is now reason to believe, as will be shown further on, were caused by 
Yellow fever. 
In the practice of the local medical men there were, of course, numerous 
cases of malaria as in other years ; there appears to me, however, to be no 
doubt that in January, May, and April the number of “fever” cases were 
abnormally high. I am also informed by Dr. White, of the Public Health and 
Marine Hospital Service of the United States, who had charge of the Yellow 
fever prophylactic measures in New Orleans, that the same marked increase of 
what was returned as “ malaria ” was noted previous to the official declaration of 
Yellow fever. It is most probable that some of these cases were Yellow 
fever. 
With regard to the symptoms which the cases of malaria presented in 
Belize. I have been furnished with the following details. Many were cases of 
persistent fever, lasting from ten to twenty days, refractory to treatment — 
quinine without effect, fever intermittent, temperature 100- 103 pulse slow, 
60-80, urine high coloured and containing bile, bowels constipated. Or 
again, “the majority of cases dating from the end of 1904 and commence- 
ment of 1905 were complicated with jaundiced sclerae, occasional slow pulse 
and high temperature. The discolouration of the sclerae was slight, however, 
and passed off in a day or two. In the severer forms “bilious vomiting was 
recorded.” From what I have myself observed this year, and from the 
description of cases in former years where disputes have arisen over mistaken 
diagnosis, I am of opinion that it is often very difficult to distinguish between 
yellow fever and certain types of malaria, in which there may be present a 
very slow pulse, jaundice, vomiting, bleeding from the gums, delirium, reten- 
tion of urine, traces of albumin, constipation, and where quinine does not 
have any marked effect. In autopsies upon these cases I have noted in one 
instance intense congestion of the gastric mucous membrane, precisely as in 
Yellow fever. Nor does the finding of the malarial parasites in the blood by 
any means settle the diagnosis in districts in which malaria is common ; 
instances were recorded this summer in New Orleans in which obvious cases of 
