TYPHOID AND REMITTENT FEVERS. To the Editor
of
the
"
Indian Medical Gazette
Sir,?In his reply to my questions on the above subject, Surgeon Deakin has rather arbitrarily decided the point at issue, though without giving any evidence in support of his view. Most of us are already aware of Sir Win. Jenner's views, but he was necessarily unacquainted
with Indian fevers ; and many other equally differ from him, in tho the intestinal lesion is characteristic of statement that the disease." In fact, all recent experience in India goes far to prove that the very gravest doubts exist as to this lesion being so exclusively confined to enteric fever. It was to acquire information on this point that I put the questions to your correspondents. 2. Were we to accept the final clause of Surgeon Deakin's first para, as the recognized law on the point, further correspondence would be unnecessary ; but I respectfully submit that he has dogmatically laid down a law the accuracy of which is susceptible of the extremest modification. 3. In his second para, he asks a question which, if it w^re answered affirmatively, would go far to simplify our nomenclature ; it is possible that the day may coma when all fevers accompanied by intestinal lesions will be classed under one head as " enteric fevers," but as yet science has not arrived at that advanced stage; and till it does, it would be premature for us to blot out. from our nomenclature all mention of such old-established diseases as remittent fevers. 4. As far as our present knowledge extends, the causation of Indian remittent fevers, and enteric fever as recognized in" Europe, is different; would Surgeon Deakin an error in diagnosis" had been made assert that if a case which had a purely malarial origin, free from all pythogenic influences, were recorded as remittent
practically
widely experienced pathologists "
24
THE INDIAN MEDICAL GAZETTE.
and simply on the ground that post-mortem lesions of intestinal glands were found ? If so, surely lie lias some reason for his belief ? 5. Until we have clear evidence that intestinal lesions are invariably absent in remittent fever, i. e , the fever we recognize as having a malarial origin, it is manifestly impossible to concede the point that all such fevers accompanied by morbid changes in Peyer's glands are cases of enteric fever. G. His last para, demonstrates the utter confusion into which the whole subject has fallen. Long ago, learned physicians collected all their forces together to prove the differential diagnosis by which typhus and enteric fevers might be distinguished from one another ; and, to our finite minds, they appeared to have, in some degree But now, alas! what at least, succeeded in their object. do we perceive ? That one of the leading physicians of our time is shown as endeavouring to draw us back again to the difficulty from which we have but just emerged ; and to prove to us that all the fine distinctions which have been so elaborately drawn between the two diseases are but cobwebs to be swept away under our new light. 7. What then is the position? Sir William Stokes insists on " the greater or less identity of enteric and typhus fevers." Surgeon Deakin doubts "whether there are such diseases as remittent and infantile remittent fevers to be met with in India as distinct from enteric fever." In other words, he considers them to be the same disease under different names. 8 Assuming then that both these great authorities are right in their respective views, we arrive at the conclusion that remittent fever, enteric fever, and typhus fever are one and the same disease. How many of your correspondents will accept this belief ? Edwin Fairland. Luclcnow, August 12 tli, 1879.
fever;
^
[January 1,
1880.
of
the
"
Indian Medical Gazette
Sir,?In his reply to my questions on the above subject, Surgeon Deakin has rather arbitrarily decided the point at issue, though without giving any evidence in support of his view. Most of us are already aware of Sir Win. Jenner's views, but he was necessarily unacquainted
with Indian fevers ; and many other equally differ from him, in tho the intestinal lesion is characteristic of statement that the disease." In fact, all recent experience in India goes far to prove that the very gravest doubts exist as to this lesion being so exclusively confined to enteric fever. It was to acquire information on this point that I put the questions to your correspondents. 2. Were we to accept the final clause of Surgeon Deakin's first para, as the recognized law on the point, further correspondence would be unnecessary ; but I respectfully submit that he has dogmatically laid down a law the accuracy of which is susceptible of the extremest modification. 3. In his second para, he asks a question which, if it w^re answered affirmatively, would go far to simplify our nomenclature ; it is possible that the day may coma when all fevers accompanied by intestinal lesions will be classed under one head as " enteric fevers," but as yet science has not arrived at that advanced stage; and till it does, it would be premature for us to blot out. from our nomenclature all mention of such old-established diseases as remittent fevers. 4. As far as our present knowledge extends, the causation of Indian remittent fevers, and enteric fever as recognized in" Europe, is different; would Surgeon Deakin an error in diagnosis" had been made assert that if a case which had a purely malarial origin, free from all pythogenic influences, were recorded as remittent
practically
widely experienced pathologists "
24
THE INDIAN MEDICAL GAZETTE.
and simply on the ground that post-mortem lesions of intestinal glands were found ? If so, surely lie lias some reason for his belief ? 5. Until we have clear evidence that intestinal lesions are invariably absent in remittent fever, i. e , the fever we recognize as having a malarial origin, it is manifestly impossible to concede the point that all such fevers accompanied by morbid changes in Peyer's glands are cases of enteric fever. G. His last para, demonstrates the utter confusion into which the whole subject has fallen. Long ago, learned physicians collected all their forces together to prove the differential diagnosis by which typhus and enteric fevers might be distinguished from one another ; and, to our finite minds, they appeared to have, in some degree But now, alas! what at least, succeeded in their object. do we perceive ? That one of the leading physicians of our time is shown as endeavouring to draw us back again to the difficulty from which we have but just emerged ; and to prove to us that all the fine distinctions which have been so elaborately drawn between the two diseases are but cobwebs to be swept away under our new light. 7. What then is the position? Sir William Stokes insists on " the greater or less identity of enteric and typhus fevers." Surgeon Deakin doubts "whether there are such diseases as remittent and infantile remittent fevers to be met with in India as distinct from enteric fever." In other words, he considers them to be the same disease under different names. 8 Assuming then that both these great authorities are right in their respective views, we arrive at the conclusion that remittent fever, enteric fever, and typhus fever are one and the same disease. How many of your correspondents will accept this belief ? Edwin Fairland. Luclcnow, August 12 tli, 1879.
fever;
^
[January 1,
1880.
