1889 Journal of the American Medical Association  
temperature, overwhelming pulmonary engorge¬ ment and fatal termination within four days-and sometimes within forty-eight hours-without any remission. Moreover, I have observed cases of approximately similar character in relation with domiciliary conditions and localities, especially foul cellars and cellars exposed to gaseous emana¬ tions from foul soil surroundings, insomuch as to be fully satisfied in my own mind that a very large percentage of the numerous deaths from pneu¬ monia in the
more » ... er time, among children and other persons mostly confined to indoors, in the colder regions of the United States-1in the coun¬ try as well as in cities-is due to malaria and pre¬ ventable by sanitary measures. Other exceptions are found in persistent chronic congestions of the liver and spleen, resulting in dropsies, and congestion of the spinal meninges, giving rise to the persistent pains, aches and neu¬ ralgias common to the inhabitants of most ma¬ larial regions and domiciliary abodes, such as those indicated, and more or less proportional with the extent of the conditions. Dengue, too, may be mentioned as a generally recognized distinct type of malarial fever, with exceptional symptoms, mostly limited to regions where the conditions which give rise to malaria exist in greatest intensity. With regard to your final propositions-"What is malaria' ' and ' ' what evidence is there for or against a malarial germ?" The correct reply is yet to be discovered. The practical conclusions deducible from the foregoing summary are : i. Malaria is coincident with accumulations of organic matter in process of putrefaction in allu¬ vial bottoms, on the margins of sluggish streams, low humid borders of stagnant ponds and lakes, the marshy borders of the sea-shore, and circum¬ scribed local conditions, chiefly artificial, compre¬ hending more or less the same relations to vege¬ table debris and other organic matter in process of decay as the outlying conditions mentioned in this connection. 2. While it is not possible in the present state of our knowledge to determine the special relations existing between malarial diseases and the geolog¬ ical, thermal, hygrometrical and barometrical con¬ ditions under which they occur, those thermal and hygrometrical conditions most promoti ve of putre¬ faction coincident with the absence of sunlight are in the highest degree promotive of malarial poison. Medical, gentlemen desiring to become mem¬ bers of the Association, can do so by securing the endorsement of the President and Secretary of the local society to which they belong, and en¬ closing the application with the membership fee
doi:10.1001/jama.1889.02400820003001a fatcat:5s6cxwh7kzacrjnr6teidkqzfe