1366 THE ENTEROIDEA GROUP OF TROPICAL FEVERS 



year Thomson described enteric fever in New Zealand, and Ripley 

 about the same time in Fiji. In 1865 Massey recognized it in 

 Newera Eliya, in Ceylon, while its occurrence in Trinidad and the 

 Bermudas was known in 1866, and Davidson, in 1868, described it in 

 Madagascar. In 1877 Defant said it was common in Senegambia. 



Notwithstanding all this early work, the fact of its prevalence in 

 the tropics was not generally recognized, the disease being concealed 

 under the terms ' remittent fever ' and ' malarial fever ' with ulcers, 

 which latter became the so-called ' typho-malarial fever,' which we 

 now know to be a mixed infection — enteric fever complicated by 

 malaria. The cause of this long delay in the general diagnosis 

 appears to have been the slow recognition of the disease by the pro- 

 fession as a whole in England, which reflected itself upon India and 

 the British Colonies; while the authority of Morehead, who in the 

 first edition of his book, ' Researches on Disease in India,' stated 

 that typhoid fever was unknown in that country, is also believed 

 to have had a deterrent effect upon the diagnosis of enteric fever 

 therein. He, however, soon doubted the correctness of his original 

 statement, for in i860 he writes that in 1856 he recognized the 

 disease in Bombay, and he quotes a lecture given by Goodeve on 

 seven cases of undoubted typhoid fever; still, he is of the opinion 

 that typhoid fever will be found in extra-tropical India or in inter- 

 tropical provinces in the near proximity of the tropics. 



Another point which prevented the general recognition of enteric 

 fever was the supposed antagonism of malaria to it, and the 

 immunity of malarial districts from its attacks. These views were 

 simply based upon the opinion that all remittent fevers were 

 malarial, and that swelling and ulcerations of Peyer's patches could 

 take place in these fevers; and the practitioner in the tropics was 

 carefully warned that he was not justified in asserting the existence 

 of typhoid fever from the mere character of the post-mortem 

 appearances, and that the so-called ' typhoid symptoms ' were not 

 peculiar to one form of fever, but might occur in all. 



Such teaching probably had a marked effect upon the diagnosis 

 of enteric fever in the tropics until the recent establishment of 

 bacteriological institutions, wherein a bacteriological diagnosis 

 could be made. 



Still more recent is the general recognition of the fact that the 

 disease may be prevalent among the natives; in Ceylon, however, 

 the fact that the malady is common among natives has been recog- 

 nized for several years, and typhoid wards for natives have been 

 established, as well as a special typhoid hospital. 



It may now be said that it is well known that enteric fever is 

 prevalent in many, if not most, tropical countries, and that it 

 occurs, not merely in Europeans, but in natives also. 



etiology. — Enteric fever is caused by the B. typhosus Eberth, 

 B. paratyphosus A Schottmiiller, B. paratyphosus B Schottmiiller. 

 The description of these germs may be found in any manual of 

 bacteriology. It is probable that there are several varieties of 



