MALAEIA. 055 



Tho error in diagnosis, upon which the inference has l)cen based that 

 mahirial fevers may be contracted through drinking water, has been 

 widespread, in this country, in Europe and 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 mala- 

 rial fevers prevail in the city of Rome, yet everyone knows how frc- 

 quenth^ 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-malariar' fevers are reported in locali- 

 ties where tN'pical malarial fevers (intermittents) are unknown, and at 

 seasons of the yeav when these fevers do not prevail even in the marshy 

 regions where they are of animal occurrence, during the mosqinto 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 8uital)le as Itreeding places 

 for AnopJielcs. 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 nmst l)e remembered that a remittent or inter- 

 mittent 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. 

 The formation of an abscess, an attack of tonsilitis, etc., are usually 

 attended by chills and fever, which may recur at more or less regular 

 intervals. ^ Indeed, in certain cases of pyemia the febrile phenomena 

 are so similar to those of a malarial attack that a mistake in diagnosis 

 is no unusual occurrence. Finally, I may say that it is the fashion 

 with many persons and with some physicians to ascribe a variety of 

 symptoms, due to various causes, to -malaria'' and to prescribe 

 quinine as a general panacea. Thus a gentleman who has been at the 

 club until 1 or 2 o'clock at night and has smoked half a dozen cigars- 

 not to mention beer and cheese sandwiches as possible factors-reports 

 to his doctor the next morning with a dull headache, a furred tongue, 

 and a loss of appetite which he is unable to account for except upon 



