Epidemic of continued fever / by Patrick Manson.

  • Manson, Patrick, Sir, 1844-1922.
Date:
1880
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Licence: Public Domain Mark

Credit: Epidemic of continued fever / by Patrick Manson. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    three-quarters of a mile distant, and in a most salubrious situation. It might be suggested that in course of their occupation as missionaries they may have been exposed to tlie same morbid influences, but I could trace nothing of this sort, and such a liypothesis is upset by the fact that the other two cases—husband and wife—were entirely UTiconnected with the missionary circle, and lived at some distance from any missionary's house. The only circumstance that I can discover connecting these six cases is the fact I have already stated, that all of them consumed milk from the same dairy, or from dairies situated in the locality I have already indicated as the focus of the epidemic among the Chinese. In my Report for the year ended 30th September 1879,* I remarked that there had been a circumscribed epidemic of what I believed to be typhoid fever on Kulangsu in the autumn of 1878. Curiously enough, this epidemic affected the same group of houses frorc\ which all the Chinese cases of this year came. The fact that all of these cases occurred in a small community about the same time, and the majority of them in the same locality, amounts to presumptive proof that all of them were examples of the same disease. But that this disease was genuine typhoid is by no means so certain. In some, the symptoms supposed to be characteristic of this disease Avere present; in others, again, beyond the facts that the fever Avas continued and Avas uncontrolled V)y quinine, there AA'as no evidence of its typhoid nature. One case was decidedly intermitting, but in this instance quinine completely failed, so that it Avas probably non-malarial; but in another case—that of the little boy Avhose sister died—quinine appeared to cut the disease short at once. An ingenious explanation of such anomalous fevers has been invented, and in plnce of candidly admitting that Ave really know little or nothing of their real nature, it has been affirmed that they are a combination of ordinary typhoid and intermittent or remittent fever, and the name typho-malarial applied to them. I do not think there is satisfactory evidence for the existence of such things as hybrid fevers. The old notion that the poisons of scarlet fever and measles sometimes combine to produce a third species of exanthematous fever has been abandoned. If Ave believe in the germ theory of the fevers, and that the germs are specifically distinct, it is difficult to conceive of the marriage of the distinct species. I do not think it likely that the specific typhoid germ and the specific malaria germ could combine to produce a hybrid germ. Possibly the typhoid germ might be swalloAved by one already infected by malaria, or vice versa; but such an accident must be very rare, and epidemics of such a combined disease would be sure to be accompanied by a preponderating proportion of pure malarial fever and pure typhoid fever. An epidemic of typho-malarial fever could not occur in a community otherwise nearly entirely free from pure malarial fever and pure typhoid fever. The truth is we are nearly entirely ignorant of a number of specific fevers Avhich from time to time aff'ect the inhabitants of foreign countries. I frequently meet Avith cases of continued fever both in foreigners and natives which do not admit of diagnosis and classification. For example, the case of fever imported from Tamsui last autumn, the temperature chart in connexion with which was noted as follows:— * See Customs Medical Reports, xviii, 58.