6

from some of the Southern States were among the first observers to describe the
disease, which has a wide distribution throughout the more malarious portions of
that country.

   That this distribution of Black-water Fever agrees in the main with that of the
greatest intensity of malaria is evident; but it has been objected:

   (1) That in the case of many of these countries the disease has only recently
been introduced.

   (2) That the coincidence with malaria is not exact; and more specially
that there are countries notoriously malarious in which Black-water
Fever is very rare, or does not exist.

   The converse of this latter suggestion, namely, that Black-water Fever occurs
in comparatively non-malarious districts has not so far as we are aware been ad-
vanced.

   (1) The belief that Black-water Fever had a peculiar and restricted distri-
bution has been emphasised in most text-books until quite recent years. To ex-
plain the constantly increasing area from which the disease is now being recorded
some writers have advanced the view that in many of these countries, as for ex-
ample India, the disease has only recently been introduced. This does not seem
to us a conclusion warranted by the facts.

   In making an examination of the literature of Black-water Fever one cannot
help remarking that the recognition of its geographical distribution, as we now
know it, has been a very gradual process, in the history of which it is possible to
distinguish certain definite periods.

   The first may be called the French Period, and dates from the time when Le-
beau (12), Daullé (13), and Le Roy de Mericourt (14) first described the disease
" Fievre Bilious Hæmaturique" as occurring in Madagascar and some of the ad-
jacent islands. Almost immediately other French physicians reported finding
the same type of fever in Senegambia, Senegal, Gaboon, Guiana, the Antilles,
and other parts of the West Indies.

   Until 1858 nothing' was heard of hæmoglobinuric fever outside French pos-
sessions. But in that year Verratas (15) a Greek, described what he termed
"Quinine Hæmoglobinuria"; and two years later a similar communication was
made by another Greek, Papabasilos (16).

   The American period commences from about 1860. The disease was first
described by Doctor Cummings (17) of Louisiana in 1859, and it was shortly
afterwards recognised in Alabama and Texas (1866). From this time onward it
was reported with increasing frequency from many parts of the Southern States
of North America.