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Further, in Madras we discovered the existence of blackwater fever, the existence of which was quite unknown, even to medical men in India. We believe, in fact, that there is rather a very close and even exact parallel between the distribution of blackwater fever and severe malaria.

2. An accurate history of blackwater fever cases will always reveal that the patient bas suffered more or less constantly from previous attacks of fever, and that for a day or two previous to his attack he has had a more or less markedly high temperature. That this temperature is of malarial origin is shown by microscopical evidence, for,

3. If the blood of a patient about to suffer from blackwater fever is examined by chance before the onset of the disease, and before the taking of quinine, it is almost invariably the case that malarial parasites are easily found. Au examination of the same case after the onset of the blackwater is, however, most frequently negative as regards parasites. Thus Panse, in a recent paper (Zeitschrift für Hygiene, s. i. 1903; found parasites without exception in all those cases which he was able to examine immediately before the onset of the haemoglobinuria; and arrives at exactly the same conclusion as ourselves as to the direct dependence of blackwater on malarial infection.

4. That blackwater fever affects residents mainly in their second and third year suggests that it occurs in conditions of chronic malarial infection, and is strongly against a view which has been suggested that blackwater fever is due to a special parasite. Thus Berenger-Féraud* gives the following data, 1st year, 5.4 per cent., 2nd year, 22.5 per per cent., 3rd year, 42.5 per cent., 4th year, 20 per cent., 5th year, 4.8 per cent.

5. Again, the fact that in West Africa and other regions where blackwater fever occurs Europeans die not so much of malaria but of blackwater fever, seems to admit only of one conclusion. To give more exact figures it appears that in the German Colonial possessions out of 3,000 cases of malaria there were 8 deaths only from ordinary malaria, but 62 from blackwater fever. However we consider these general points they all clearly point to the malarial origin of blackwater fever, though, as we have said, the real evidence depends upon the microscopical evidence of malaria in blackwater.

Blackwater fever, then, is malarial in its nature, and its prophylaxis is consequently identical with that of malaria.

J. W. W. STEPHENS, M.D., Cantab. S. R. CRISTOPHERS, M.B. Vict., I.M.S.

February 4, 1903.

Enclosure No. 3.

THE SECRETARY TO THE ROYAL SOCIETY to COLONIAL OFFICE.

(Received May 4, 1903.)

The Royal Society, Burlington House, London, W., May 2. 1905. SIR, THE valuable results of the efforts made under your initiative towards the pre- vention of malaria in the Colonies, encourages me to lay before you the following considerations.

In many parts of the Empire, especially in tropical and sub-tropical countries. the development of Imperial interests is often most seriouly impeded or even imperilled by the occurrence of diseases. Some of these, like malaria, yellow fever, sleeping sickness, beri-beri and many others attack man himself. Others, such as horse sickness, rinderpest, redwater, tzetze fly disease and many others attack the domestic animals which man uses.

These diseases, for the most part, do not exist in the British Isles, or are not seen there in the form in which they occur in foreign parts.. Hence the knowledge

· La Fièvre Bileuse Melanurique."