370 POPULAR SCIENCE MONTHLY. 



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 in- 

 gestion of contaminated water or food. The error in diagnosis, upon 

 which the inference has been based that malarial fevers may be con- 

 tracted through drinking water, has been widespread, in this coun- 

 try, 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 cate- 

 gory, 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 ma- 

 larial fevers prevail in the city of Rome, yet every one knows how fre- 

 quently 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 sea- 

 sons of the year when these fevers do not prevail even in the marshy re- 

 gions 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 in- 

 termittent 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. 



