Page:Popular Science Monthly Volume 58.djvu/378

370 published in 1883. The fevers supposed to have been contracted in this way are, as a rule, continued or remittent in character and they are known under a variety of names. Thus we have 'Roman fever' 'Naples fever' 'Remittent fever' 'Mountain fever' 'Typho-malarial fever' etc. The leading physicians and pathologists, in regions where these fevers prevail, are now convinced that they are not malarial fevers, but are simply more or less typical varieties of typhoid fever—a disease due to a specific bacillus and which is commonly contracted as a result of the ingestion of contaminated water or food. The error in diagnosis, upon which the inference has been based that malarial fevers may be contracted through drinking water, has been widespread, in this country, in Europe and in the British possessions in India. It vitiated our medical statistics of the Civil War and of the recent war with Spain. In my work already referred to, I say:

"Probably one of the most common mistakes in diagnosis, made in all parts of the world where malarial and enteric fevers are endemic, is that of calling an attack of fever, belonging to the last mentioned category, malarial remittent. This arises from the difficulties attending a differential diagnosis at the outset, and from the fact that having once made a diagnosis of malarial fever, the physician, even if convinced later that a mistake has been made, does not always feel willing to confess it. The case, therefore, appears in the mortality returns, if it prove fatal, or in the statistical reports of disease, if made by an army or navy surgeon, as at first diagnosed."

I have already mentioned the fact that Marchiafava denies that malarial fevers prevail in the city of Rome, yet every one knows how frequently travelers contract the so-called 'Roman fever' as a result of a temporary residence in that city. In our own cities numerous cases of so-called 'remittent' or 'typho-malarial' fevers are reported in localities where typical malarial fevers (intermittents) are unknown, and at seasons of the year when these fevers do not prevail even in the marshy regions where they are of annual occurrence—during the mosquito season. Malarial fevers may, of course, occur in cities as a result of exposure elsewhere to the bites of infected mosquitoes of the genus Anopheles, either as primary attacks or as a relapse, or in urban localities in the vicinity of marshy places or pools of water suitable as breeding places for Anopheles. But when a previously healthy individual, living in a well-paved city, in a locality remote from all swampy places is taken sick with a 'remittent fever,' and especially when the attack occurs during the winter months, it is pretty safe to say that he is not suffering from malarial infection, and the chances are greatly in favor of the view that he has typhoid fever. It must be remembered that a remittent or intermittent course is not peculiar to malarial fevers. Typhoid commonly presents a more or less remittent character, especially at the outset of an attack; the hectic fever of tuberculosis is intermittent in character.