gave expression to an opinion which will heartily commend itself, we think, to all who are interested in the
difficult, but necessary, task of the differentiation of the fevers of India, viz., that a new heading "fevers not classified" be used in returns.
might
Dr. Crombie's two (and let us not say
addresses, "last") Indian Medical Congress, and the other at last year's meeting of the British Medical Association, have gone far to pave the way one
at
our
first
towards this most desirable goal. There are us who, in the course of a few of very year's experience, do not meet with more than one case of fever, which it is simply impossible to press into the somewhat rigid Procrustean bed of the official
"
clature
no one
implies
that that
Nomenclature of Disease." The value and necessity of using such a book as the Nomenwill
deny, but compilation
this
by
no means
is without
and that all the diseases met with
in
countries will naturally
a
fall under
fault, tropical
suitable
It is
heading. especiall}7, with tropical fevers that this difficulty is met; the practitioner at home but rarely meets a case which is not sufficiently obedient to
type
as
to fall under the main head-
In the latest edition of the
ings.
Nomenclature,
half-hearted advance has been made, in that, owing, the preface says, to the representations one
of officers of the has been
Army, the term tentatively introduced as a
Malta fever sort of sub-
heading to enteric fever. Why it should be so placed, thereby giving the uninitiated to imagine
that it had some connection with the latter disease, is hard to understand, but even this partial recognition is better than none, and it premedical
vents
officers
in
our
to return
stations from having fever under the absurd
continued fever," with the far
enteric at
all,
or
or
more
malaria.
concerns us
serum
on
mix
simple
them up diseases
important fever, however, little if India; nevertheless, bearing
in
or
Wright's
men
tests with
returned from
would welcome
reports
station
which
hospitals,
"
of
This
in mind Professor fever
of undulant
cases
heading
worse, to
fatal
Mediterranean
of
seem
cases
Malta
India,
we
occurring
to medical
in
officers
In fact, it medical men of all abnormal cases notes take kindly and send them to us India in fever of continued much for publication, good might be done, Another suggestion may be offered, which to resemble Malta fever.
THE In
SUGGESTED NEW HEADING NOT CLASSIFIED." more
Report
Government of
FEVERS
one part of the last Annual Sanitary Commissioner to the India, Surgeon-General Harvey
than
of the
"
would
would
undoubtedly
be useful and
interesting,
is
1899
g
that
some
crusade against
THE
1
of
us
would
classify
the MOSQUITO.
339
malaria. We have known some writers to talk all the fevers met " " of intermittent or "remittent" pneumonia
year's hospital or private prac-and even dysentery,and undoubtedly many meditice, according to the provisional schemecal mistake the rise subordinates in this with
in
a
country Ihis and fall of the temperature in a hectic or a would imply 110 belief in its finality or its pysemic fever for malaria from a blind reliance an extent accuracy, but it would show to what on this most unreliable symptom. the unclassified fevers of Dr. Crombie's list are Protest has already been made in these met with in the experience of others. We have columns against the abolition from the Nomenclaalready, in reviewing Major Spencer's little book, ture of "malarial cachexia "?a term for a condipointed out the value of every attempt at tion recognised and described in every country differentiation. We admit that it is very diffi- and in every text-book on diseases of warm cult to do much in this line with merely cliniclimates, To return such a case tout court as cal means. Malta fever, for example, was clini- " malaria" would be logical, but to be forced to " cally recognised for years before its general return it as'either "ague" or remittent fever," acceptance. It was Bruce's discovery (which we when, as Major Ross has pointed out, the fever are glad to see rewarded by an F. R. S.) of the is secondary and refractor}7 to quinine is to force micrococcus that won for this fever recognition us to falsify our statistics as long as such a as an entity. On the other hand, we may reruling remains in force. It is perhaps too soon member that it was by clinical investigation to stereot}7pe a classification of the malarial and observation alone that typhoid fever was fevers according to the variety of the parasite separated from typhus, and the other continued present. We must await further research before fevers of Great Britain, by Jenner and Stewart. we can expect these modern views to be accepted To rerurn, however, to Surgeon General so thoroughly as to give them local habitation Harvey's remark quoted at the commencement and name in a semi-official book like the Nomenof this article. He shrewdly remarks that the clature. only objection to the introduction of a new In conclusion, we heartily recommend Surgeonheading in our returns for " fevers not classified" General Harvey's suggestion of a new heading, is that it might encourage slackness in diagnosis. " Fevers not yet classified," to the consideration This objection, however, would be easily met by of our readers, by whom we believe it will be directing that full details with a clinical history welcomed. and a temperature chart should be given for all sketched
out for
us
Crombie.
Dr.
by
-
cases entered under the new heading. The medical officer who has such an interesting case in his charge, and has thought so much about it
hesitate about returning it under recog-
to
as
nised
headings,
step further account long, necessarily of his reasons for so of this rule A concluding. kind has been very to in force wisely put prevent a too frequent use of that obscure and all-embracing term "remittent fever," and it has and
give
a
the merit of
will
brief,
surely
go
one
not
insisting
upon
an
the term is used.
explanation why
The mention of "remittent fever leads us to another weak point in our Nomenclature of Disease. Nothing has, in our opinion, been so "
fruitful of mischief as the old student-day's view of the essential qualities of the malarial fevers. The tendency to judge of the nature
of
a
of the
fever
by
the
picture
pj'rexia makes upon
lias led
to many
a
the
registration temperature chart
extraordinary
views
about
difficult, but necessary, task of the differentiation of the fevers of India, viz., that a new heading "fevers not classified" be used in returns.
might
Dr. Crombie's two (and let us not say
addresses, "last") Indian Medical Congress, and the other at last year's meeting of the British Medical Association, have gone far to pave the way one
at
our
first
towards this most desirable goal. There are us who, in the course of a few of very year's experience, do not meet with more than one case of fever, which it is simply impossible to press into the somewhat rigid Procrustean bed of the official
"
clature
no one
implies
that that
Nomenclature of Disease." The value and necessity of using such a book as the Nomenwill
deny, but compilation
this
by
no means
is without
and that all the diseases met with
in
countries will naturally
a
fall under
fault, tropical
suitable
It is
heading. especiall}7, with tropical fevers that this difficulty is met; the practitioner at home but rarely meets a case which is not sufficiently obedient to
type
as
to fall under the main head-
In the latest edition of the
ings.
Nomenclature,
half-hearted advance has been made, in that, owing, the preface says, to the representations one
of officers of the has been
Army, the term tentatively introduced as a
Malta fever sort of sub-
heading to enteric fever. Why it should be so placed, thereby giving the uninitiated to imagine
that it had some connection with the latter disease, is hard to understand, but even this partial recognition is better than none, and it premedical
vents
officers
in
our
to return
stations from having fever under the absurd
continued fever," with the far
enteric at
all,
or
or
more
malaria.
concerns us
serum
on
mix
simple
them up diseases
important fever, however, little if India; nevertheless, bearing
in
or
Wright's
men
tests with
returned from
would welcome
reports
station
which
hospitals,
"
of
This
in mind Professor fever
of undulant
cases
heading
worse, to
fatal
Mediterranean
of
seem
cases
Malta
India,
we
occurring
to medical
in
officers
In fact, it medical men of all abnormal cases notes take kindly and send them to us India in fever of continued much for publication, good might be done, Another suggestion may be offered, which to resemble Malta fever.
THE In
SUGGESTED NEW HEADING NOT CLASSIFIED." more
Report
Government of
FEVERS
one part of the last Annual Sanitary Commissioner to the India, Surgeon-General Harvey
than
of the
"
would
would
undoubtedly
be useful and
interesting,
is
1899
g
that
some
crusade against
THE
1
of
us
would
classify
the MOSQUITO.
339
malaria. We have known some writers to talk all the fevers met " " of intermittent or "remittent" pneumonia
year's hospital or private prac-and even dysentery,and undoubtedly many meditice, according to the provisional schemecal mistake the rise subordinates in this with
in
a
country Ihis and fall of the temperature in a hectic or a would imply 110 belief in its finality or its pysemic fever for malaria from a blind reliance an extent accuracy, but it would show to what on this most unreliable symptom. the unclassified fevers of Dr. Crombie's list are Protest has already been made in these met with in the experience of others. We have columns against the abolition from the Nomenclaalready, in reviewing Major Spencer's little book, ture of "malarial cachexia "?a term for a condipointed out the value of every attempt at tion recognised and described in every country differentiation. We admit that it is very diffi- and in every text-book on diseases of warm cult to do much in this line with merely cliniclimates, To return such a case tout court as cal means. Malta fever, for example, was clini- " malaria" would be logical, but to be forced to " cally recognised for years before its general return it as'either "ague" or remittent fever," acceptance. It was Bruce's discovery (which we when, as Major Ross has pointed out, the fever are glad to see rewarded by an F. R. S.) of the is secondary and refractor}7 to quinine is to force micrococcus that won for this fever recognition us to falsify our statistics as long as such a as an entity. On the other hand, we may reruling remains in force. It is perhaps too soon member that it was by clinical investigation to stereot}7pe a classification of the malarial and observation alone that typhoid fever was fevers according to the variety of the parasite separated from typhus, and the other continued present. We must await further research before fevers of Great Britain, by Jenner and Stewart. we can expect these modern views to be accepted To rerurn, however, to Surgeon General so thoroughly as to give them local habitation Harvey's remark quoted at the commencement and name in a semi-official book like the Nomenof this article. He shrewdly remarks that the clature. only objection to the introduction of a new In conclusion, we heartily recommend Surgeonheading in our returns for " fevers not classified" General Harvey's suggestion of a new heading, is that it might encourage slackness in diagnosis. " Fevers not yet classified," to the consideration This objection, however, would be easily met by of our readers, by whom we believe it will be directing that full details with a clinical history welcomed. and a temperature chart should be given for all sketched
out for
us
Crombie.
Dr.
by
-
cases entered under the new heading. The medical officer who has such an interesting case in his charge, and has thought so much about it
hesitate about returning it under recog-
to
as
nised
headings,
step further account long, necessarily of his reasons for so of this rule A concluding. kind has been very to in force wisely put prevent a too frequent use of that obscure and all-embracing term "remittent fever," and it has and
give
a
the merit of
will
brief,
surely
go
one
not
insisting
upon
an
the term is used.
explanation why
The mention of "remittent fever leads us to another weak point in our Nomenclature of Disease. Nothing has, in our opinion, been so "
fruitful of mischief as the old student-day's view of the essential qualities of the malarial fevers. The tendency to judge of the nature
of
a
of the
fever
by
the
picture
pj'rexia makes upon
lias led
to many
a
the
registration temperature chart
extraordinary
views
about
