7
" I think I have cited evidence to show that in the opinion of many medical officers of
experience ulceration of the small intestines and Peyer's glands is not necessarily indicative
of specific enteric fever, but may also occur in the climatic fevers of remittent and continued
type. I believe a considerable amount of • climatic fever occurs in the tropics in which the
symptoms and phenomena so closely resemble those of true enteric fever that they may cause
one to be mistaken for the other, and that the post-mortem discovery of ulceration attests the
severity of the disease ; but this does not proclaim its original cause. All I have said, indicates
the existence of fever which is neither simple continued, ordinary remittent, nor specific
enteric, and that it should stand apart, its affinity being with malarial rather than with true
enteric fever, though it has much in common with both. It may, after all, turn out to be true
enteric fever : and were it admitted that the specific form of fever may originate in animal
effluvia and emanations generally, and is not restricted to a specific contagion developed. only
in human excrement, then it is probable enough that in such a source we may find its origin,
for there are few localities in which organic emanations do not taint the air, or pollute the
soil or water; still the fact that these conditions are often rife, and yet this form of fever so
infrequent, whilst the effects of season, locality and age play so important a part in developing
it seems to show that climatic conditions are largely concerned."
Brigade-Surgeon Marston, quoted by Sir Joseph Fayrer, says:—
" On the whole, I think as a tentative and working hypothesis there are two forms of it
in.India which cannot, however, be clinically or pathologically differentiated : One (the larger
class) which does not depend on the contagion of any specific poison generated in the intes-
tines of one person and conveyed to another through some vehicle, nor induced in any
fæcal poisoning or poisoning of any kind unless it be that the patient is autogenetically
poisoned by his own fæcal matters; the other occurring in outbreaks (not singly in isolated
cases) and with a history by which the cases can be traced to some common cause, such. as
infection, fouled air or water, diseased or tainted meat, &c. These attacks occur in communi-
ties at one and the same time, or following one another quickly among men of the. same
corps and placed in the same conditions, and the ages and length of tropical service of the
men are often very different to those of the other variety. Occurring under the circumstances
stated, age and service are indifferent elements; within the limits of a soldier's age any man
may be atacked, though the young and recently arrived are more predisposed. In the first
variety, however, I am disposed to think that climate, meaning by it the whole combination
of changed physiological conditions environing the young and newly arrived soldier in this
country, plays a very important if not the main part."
I have given the above extracts in extenso in order to show Government the
very great diversity of opinion that exists amongst eminent members of the
profession at home and abroad as to the origin and causation of enteric fever, and
whilst so many points of cardinal importance remain undecided, it is evident that
only opinions can be formed in favour of one theory or the other which would
be unsafe to trust to for practical action.