5
embodies an opinion held for a long time past by practitioners in malarial sections of this-
country, and the term ' Typho-malarial Fever' has been introduced by Dr. J. J. Woodward.
" Typho-malarialfever is caused by the combined action of malaria and the special cause of
typhoid fever. Practitioners in malarial situations have been accustomed to say that remittent
becomes converted into typhoid fever. This mode of expression is not accurate. There is
not a metamorphosis of the one disease into the other, but a combination of both diseases,
the phenomena of the one or of the other disease predominating in different, cases. Typho-
malarial fever is not a distinct type of fever. It is, however, of great importance to recognize
the combination of typhoid and of malarial fever.
" Cases of typho-malarial fever occur in most, if not all, malarial regions. This fact shows
that the special cause of typhoid fever is not held in abeyance by the prevalence of malaria
and produced only after the latter disappears. The extinction of malaria is followed by
cases of unmixed typhoid fever, and hence it has appeared as if the latter follows in the
wake of periodical fevers. Simple remittent or typho-malarial fevers prevail especially in the
autumnal season. Persons of all ages are liable to be affected by simple remittent fever. There
is no evidence that this fever is ever contagious, nor that the malarial poison producing it is
portable.
" Typho-malarial fever is discriminated on the one hand from simple remittent fever by
the characteristic events of typhoid fever, namely,—the abdominal symptoms, the eruption in
some cases, the earlier occurrence of ataxic phenomena, epistaxis, and, occasionally,
intestinal perforation. It is discriminated on the other hand from unmixed typhoid fever by
the characteristic events of periodical fever, namely,—remissions, gastric symptoms, jaundice,
and the eventuation in some cases in intermittent fever.—Austin Flint's Practice of Medicine,
5th edition."
Turning to India we find, although, from the description of cases given by
Annesley and other authors, enteric fever must have existed in their time, yet it
was not recognized as a distinct disease before 1853, when it was described by
Assistant Surgeon Scriven of the Bengal Medical Service as occurring among
Europeans and afterwards by Dr. Bwart as being met with among natives of India
(Sir J. Fayrer Croonian Lectures).
The disease as a cause of sickness and mortality among British Troops in India
was first brought into prominent notice by the invaluable writings of the late
Dr. Bryden, who, from his position as Statistical Officer attached to the Sanitary
Commissioner with the Government of India, had unrivalled opportunities of
studying disease causes as they affect not only the European but also the Native
Army of India as well as the jail and general population, and to whom we are
indebted for the most comprehensive information on the subject which he has
embodied in his well known statistical tables.
In the Vital Statistics of the Bengal Presidency for the 10 years, 1860—69,
Dr. Bryden says :—
" The continued fever from which boys die is in almost every instance true typhoid fever.
Although it occurs in every month, it is in the hot months that three-fourths of the deaths
from typhoid fever occur. The typhoid lesion is the characteristic of the fatal fever of the
unacclimatized, and the phenomena of the fever are those of true enteric fever. It is not only
among the boys that this fever becomes developed, young men up to 24 are equally liable to
suffer, and cases will be found pretty numerous among men of the 3rd group; and occasionally
the fever is seen even in men above 30.
" The fever from which the young men die is a fever of the hot season. My experience
of the statistics of new troops leads me to draw the inference that the typhoid lesion is in
almost every case present when the continued fever of the hot season proves fatal to the
young.
" I wish to express the practical truth that every body of young men which comes to
India may be expected to suffer from typhoid in the first hot season not because of a special
poisoning derived from the locality in which it may be placed, but because in the young
when the influence of heat tells on the nervous system, infiltration in Peyer's glands follows,
the characteristic eruption is manifested, and the fever pursues its course and ends in resolu-
tion or in death.
" Let me repeat that I know of no single circumstance that could suggest to me that the
type of the fever is determined by local causes. Typhoid has no geography, and it is of
universal occurrence. But in making this broad assertion I would not be misunderstood ;
that there is a zymotic element developed in every individual case of typhoid I believe to
be a fact, and a truth that should be acted on in any case as soon as typhoid makes its
appearance in a body of men.
" A further theory suggests that typhoid may be acquired from contagium from the
native population. I know of no single record of the existence of typhoid among the native
B 357—2