SCIENCE 



NEW YORK, APRIL 10, 1891. 



MALARIA AND THE CAUSATION OF INTERMITTENT 

 FEVER. 1 



Dr. ToMMASl-CEUDELiand others have claimed that intermittent 

 fever is caused by a bacillus. 



Drs. Laveran, Osier, Council, and others have proved, to their 

 own satisfaction at least, that intermittent fever is caused by a 

 microscopic hgematozoOn. 



At the meeting of the American Medical Association in Cincin- 

 nati, in May, 1888, I presented what I then considered, and still 

 consider, to be incontrovertible evidence that intermittent fever 

 is caused by exposure to changes of atmospheric temperature ; that 

 ordinarily its causation is quantitatively related to, and apparently 

 controlled by, the range of atmospheric temperature. 2 It seems 

 to me that both these lines of evidence, which appear to be so 

 divergent, may be true. I feel sure that my own line is; and I 

 have very great confidence in those who have presented the other 

 line of evidence in which they are expert. 



Therefore, although those who have held the germ theory of 

 the causation of intermittent fever have not, so far as I know, 

 accepted the evidence which I have collected and published, yet I 

 feel impelled to again ask attention to it. I attempt this the 

 more readily, because the facts and considerations, which it seems 

 to me to make it appear possible that both lines of evidence may 

 be true, were, in the main, held in mind when I read my paper 

 two years ago; but there was not then time to elaborate, and I 

 therefore only referred to, but did not fully state them. 



I suppose that all here are probably familiar with the literature 

 of the subject of the bacillus of malaria, and also that relative to 

 the hsematozoon of malaria, discovered by Laveran. I may there- 

 fore devote my time exclusively to that other phase of the subject 

 on which I have collected evidence, and which is probably little 

 known. 



The most important evidence which has been presented by my- 

 self is as follows: — 



1. Statistics of sickness from intermittent fever in Michigan 

 during a long series of years, arranged to show the relation of in- 

 termittent fever to changes in atmospheric conditions, and which 

 have proved to my mind that the controlling condition is asso- 

 ciated with atmospheric temperature, the sickness rising and fall- 

 ing with the temperature. 



3. Statistics relative to intermittent fever in the United States 

 armies, elaborated from the medical and surgical history of the 

 war of 1861-65. 



An abstract of a summary of conclusions, based upon the evi- 

 dence which I collected, is as follows : — 



" 2. The controlling cause of intermittent fever is exposure to 

 insidious changes, or changes to which one is unaccustomed, in 

 the atmospheric temperature 



"3. In the mechanism of the causation of intermittent fever, 

 the chief factor is the delay in re-action from exposure to cool air. 

 This delay, extending 10 a time when greater heat-loss should 

 occur, results ia the abnormal accumulation of heat in the interior 

 of the body, and m disturbed nervous action, — the chill; and the 

 final re-action is excessive, because of the accumulation of heat, 

 and sometimes because it occurs at the warmest part of the day. 



"4. The fever is the excessive re-action from the insidious in- 

 fluence of the exposure to cool air ; and it is periodical because of 



* Abstract of a paper read at the forty-flrst annual meetiug of the Ameri- 

 can Medical Association at Nashville, Tenn , May, 1890, by Henry B. Baker, 

 M.D., of Lansing, Mich. 



2 " Malaria and the Causation of Periodic Fever ' (Journal of the American 

 . Medica' Assooiatlou, Nov. 10, 1888). 



the periodicity of nervous action, and, because the exposure and 

 the consequent chill are periodical, owing to the nightly absence 

 of the warmth from the sun. 



"5. Residence in valleys or low lands through which or upon 

 which cold air flows at night, and thus causes insidious changes 

 in the atmospheric temperature, favors intermittent fever. 



" 6 In our climate, those measures, such as drainage, which 

 enable the soil to retain warmth during the night, and thus reduce 

 the daily range of temperature immediately over such soil, tend to 

 decrease intermittent fever among residents thereon. 



"7. In the cure and prophylaxis of intermittent fever, those 

 remedies are useful which lessen torpidity and tend to increase 

 the power of the body to re-act promptly to insidious changes in 

 atmospheric temperature." 



Preparing, now, to forge a link, in the chain of evidence, which 

 was omitted from my paper, i?ir William Moore, who has had 

 great experience and observation in India, says, " So-called mala- 

 rious fevers are caused by sudden abstraction of heat, or chill, 

 under the influence of cold, and more especially of damp cold. 

 These effects of chill are more marked in hot climates, because of 

 the antecedent exposui-e to great solar heat, the anaemia and 

 skin debility resulting from heat and the disregard of suitable pre- 

 cautions." 



I think that my statistics indicate that another reason for there 

 being most intermittent fever in hot climates is because the differ- 

 ence between the day and the night temperatures is the greatest 

 in hot climates, and consequently the demands upon and resulting 

 disturbances of the heat-regulating apparatus of the body are 

 greatest in hot climates. 



Intermittent fever is most prevalent in hot climates. In tem- 

 perate climates, intermittent fever is most prevalent in the warm 

 months. Here a reason similar to that just given applies, — it is 

 then that there is greatest difference between the day and the night 

 temperatures 



I believe that perspiration is probably a factor in the causation 

 of intermittent fever. I do not base this opinion merely upon the 

 facts just stated, relative to place and time of greatest prevalence, 

 but mainly upon two facts, as follows : perspiration tends to cause 

 chill, b?cause of the fact that evaporation from moist clothing 

 tends to lower the temperature rapidly. I believe that a chill, 

 especially at the warmest time of the day, is not infrequently 

 sufi&cient to start the disease intermittent fever. Excessive per- 

 spiration tends to change the condition of the blood; and chill 

 tends to change the condition of the blood in some such way as 

 follows : when the surface of the body is strongly contracted, the 

 blood is driven from all the surfaces ; the circulation is impeded ; 

 the blood parts with some of its fluid, and with it the salts, which 

 pass into the urine; then there comes a demand of the tissues for 

 blood; thirst is great, which, when satisfied, again fills up the 

 blood-vessels. This rapid changing of the proportion of fluid in 

 the blood tends, I believe, toward the solution or breaking-up of 

 the red-blood corpuscles My belief is that the destruction of the 

 red corpuscles is greater than it would be if only the proportion 

 of water in the blood was changed ; that the destruction occurs 

 partl3' through a disturbance of the proportion of certain salts in 

 the blood. It is not difficult to see how this may be. Excessive 

 perspiration takes out salts, especially sodium chloride, in con- 

 siderable quantity; the urine passes out salts in considerable quan- 

 tity. On the other hand, the water drank to quench the thirst 

 does not ordinarily take salts into the blood, except in cases where 

 common salt is given as a remedy, which is sometimes done by 

 non-professional persons. According to experiments made many 

 years ago, in the circulating blood, in health, the red corpuscles 

 are preserved by solium chloride from being dissolved in the 

 albumen. As this paper is not an exhaustive treatise on this sub- 



