Page:Tropical Diseases.djvu/318

276 malarious countries is most unequal. It is common here and there throughout tropical Africa. It is found all along the West Coast from the Senegal to the Coanza, but principally on the Congo and on the deltas of the Niger and Gambia rivers. On the East Coast it is also widely spread, especially along the Zambesi, the lower Shire, and the shores of the Nyasa. It is far from uncommon in the Upper Niger, in British and German East Africa, in Uganda, in North and South Rhodesia, in Abyssinia, and in the valley of the Upper Nile. It is also common in some parts of Madagascar. But it is not found in the malarious regions of Lower Egypt, and it is rare in Algeria. In America it extends over the Southern States of the Union, chiefly Florida, Georgia, Alabama, Mississippi, Arkansas, and Texas, but recently it has also been prevalent in North Carolina and Virginia. It is found, too, in Central America, on the plains of Venezuela and in the West Indies.

In Europe it is restricted to Greece, Sicily, and Sardinia. A few cases have been reported from Central Italy. It is extremely rare in the Roman Campagna, the classic land of malaria. In Asia it is reported from Palestine (Zicron), Tonquin, the Malay Peninsula, Formosa, and lately it has been described as occurring in Assam, Burma, Darjeeling, the Terai, Meerut, and Amritsar. It occurs in many of the malarious islands Java, Solomon Islands, etc. of the Eastern Archipelago, and also in New Guinea.

Before 1885, strange to say, no Indian writer had mentioned hæmoglobinuria as a feature in the pyretology of Hindustan or of the East. Apart from the possibility of its having been overlooked, there may be another explanation for this singular silence: the disease may have been confounded with bilious remittent. It is difficult to believe, however, that the large number of acute observers who had studied Indian diseases so carefully and for so many years could have systematically ignored this striking disease. Possibly, therefore, it is of recent introduction into