TYPHOID FEVER 67 



fever." The Germans know it as "Abdominal typhus." Gerhard of 

 Philadelphia is generally given the credit of finally settling the dispute 

 concerning the duality of the old typhus. Valliex wrote in 1839: 

 "Gerhard established for the first time the very important fact that 

 there can exist, and that there do exist, at the same time in the same 

 country two diseases that may be clearly distinguished and in which 

 one can predict during life the lesions which will be found after death. 

 These diseases are typhoid fever and the true typhus." 



Early in our civil war, medical officers reported fevers which in 

 their opinion differed from typhoid fever as seen in the north. The 

 first board, appointed (1861) to investigate this matter, reported that 

 "the fever prevalent among the soldiers was bilious remittent fever, 

 which, not having been controlled in its primary stage, has assumed 

 that adynamic type which is present in enteric fever." A second board 

 was convened (1862) for the purpose of revising the sick report. 

 Major Woodward, the chief of this board, insisted that "the prevailing 

 fevers of the army of the Potomac were hybrid forms, resulting from 

 the combined influences of malarial poisoning and of the causes of 

 typhoid fever," and he insisted that they should be reported as "typho- 

 malarial fever." This designation became official July 1, 1862, and 

 from that time to June 30, 1866, 57,400 cases, with 5,360 deaths, 

 were reported under this name. 



While Woodward's designation of the disease was adopted, his 

 understanding of its nature was quite generally ignored. He believed 

 it to be a hybrid resulting from coincident malarial and typhoid 

 infections while the greater part of the profession understood it to 

 be a severe form of malarial infection. In Woodward's opinion typho- 

 malaria was quite as severe and fatal as typhoid, because it was 

 typhoid in one already infected with malaria or vice versa. He also 

 believed that a trace of scurvy, often unrecognizable until typhoid 

 infection developed rendered the latter more grave. The majority of 

 physicians and the laity regarded typho-malaria as a severe malaria, but 

 much less grave than typhoid ; the new term took a part of the sting out 

 of the diagnosis of typhoid and many a practitioner in the kindness of 

 his heart, in his desire to spare patients and friends, found the com- 

 pound word a welcome subterfuge. With the mobilization of troops in 

 the war with Spain (1898) the same fever spread rapidly through 



