THE EUROPEAN SETTLERS 
l 79 
here, as in other parts of tropical Africa, this demon could be conjured, beyond 
all question the prosperity of Western Africa, of the Congo Basin and of British 
Central Africa would be almost unbounded. 
Ordinary malarial fever is serious but not so dangerous as that special form 
of it which is styled “black-water” or haematuric. The difference between the 
effects of the two diseases is this. Ordinary malarial fever is seldom immediately 
fatal but after continued attacks the patient is often left with some permanent 
weakness. Black-water fever is either fatal in a very few days or has such 
a weakening effect on the heart that the patient dies during convalescence from 
sudden syncope; but where black-water fever does not kill it never leaves 
(as far as I am aware) permanent effects on the system of the sufferer. One 
attack, however, predisposes to another and as a rule each succeeding attack is 
more severe than its predecessor. Consequently a man who has had, say, two 
attacks of black-water fever should not return to any part of Africa where that 
disease is endemic. 1 
The origin and history of bilious haemoglobinuric or “ black-water ” fever are 
still obscure. No mention of this disease would appear to have been made 
until the middle of this century when it was described by the French naval 
surgeons at Nossibe in Madagascar. According to Dr. Wordsworth Poole, the 
principal medical officer of the British Central Africa Protectorate, true black- 
water fever has occurred in parts of America and in the West Indies besides 
those portions of Africa and Madagascar to which I have made allusion in 
the footnote. Dr. Poole states that he has seen a case of it in Rome and that 
it is said to occur in Greece. The cases occurring in tropical America which 
Dr. Poole cites I should be inclined to ascribe to a variation of the ordinary 
type of yellow fever. Now yellow fever, in my opinion, is a very near 
connection of black-water fever, and some writers on Africa have stated that 
yellow fever was actually engendered on the slave ships which proceeded 
from West Africa to South America, and have suggested it was simply an 
acute development of the ordinary African hsemoglobinuric fever. 
One remarkable feature in this disease appears to be that assuming it is 
only endemic in certain parts of Africa, its germs would seem to be capable 
of lying dormant for some time in the human system and then to suddenly 
multiply into prodigious activity and produce an attack of black-water fever 
some time after the individual has left the infected district. For instance, 
in 1893 after having been absent nearly two months from British Central 
Africa in Cape Colony and in Natal, I had a most severe attack of black-water 
fever, which commenced at Durban on board a gunboat and finished at Delagoa 
Bay. Again, when travelling through the Tyrol in the autumn of 1894, I 
was suddenly seized with a slight but obvious attack of this fever after 
returning from a mountain ascent. Although only ill for about twenty-four 
1 At the present time black-water fever is endemic on the West Coast of Africa from the Gambia 
on the north to Benguela on the south, and inland as far as the limits of the forest country of West Africa. 
It extends over the whole of the Congo basin. I believe a few cases were noted on the White Nile and 
the western tributaries of the Nile before the Mahdi’s revolt expelled the Europeans from these parts. 
It is endemic in the regions round the Victoria Nyanza and Tanganyika; in the eastern half of British 
Central Africa; along the whole course of the Zambezi between Zumbo and its mouth ; in the Portuguese 
province of Mojambique ; in German East Africa ; and in British East Africa. It is said not to be 
endemic in the islands of Zanzibar and Pemba and that those persons who have suffered from it there brought 
the germs of it from some other part of Africa. I have not heard that it exists at Beira or south of the 
Zambezi, but should not be surprised to learn that cases of it occasionally occur there. Roughly speaking, 
it may be said that as far as we know the Upper Niger regions, the North Central and Eastern Sudan, 
Abyssinia, Somaliland, Galaland, Egypt, Northern Africa and Africa South of the Zambezi are free from 
it. It is said to occur in Madagascar. 
