It is believed in many parts of our country that there is an antagonism between typhoid fever and the various forms of malarial fever, and it is unquestionably true that in many districts in which the latter were formerly prevalent they have ceased to be frequent, and have been replaced apparently by the former. In the cultivation of the soil the causes of malarial fever disappear, or at least become less potent. On the other hand, the increase of population and the neglect of all sanitary laws in the building of towns, and the construction of sewers with their house connections, seem to favor the occurrence of typhoid fever. But there is no real antagonism between the diseases. During the recent Civil War typhoid fever was not infrequently developed in soldiers suffering from malarial disease. Indeed, so frequent was it to have the manifestations of the two diseases in the same individual that many observers at that {248} time supposed they had a new disease to deal with, to which they gave the name of typho-malarial fever. 2. EXCITING CAUSES.--Much diversity of opinion has existed in times past and to a certain extent continues to exist, in regard to the contagiousness of typhoid fever. In the early part of this century there was quite a number of good observers, including Nathan Smith in this country, and Bretonneau and Gendron of Château du Loir in France, who held the opinion it was an eminently contagious disease. Indeed, Smith went so far as to say that its contagiousness was as fully demonstrated as that of measles, small-pox, or any other disease universally admitted to be contagious. This was also the opinion of William Budd, who maintained that the contagious nature of typhoid fever was the master truth in its history. The late Sir Thomas Watson was also a warm supporter of the same view. At the present time, however, the large majority of physicians, whose opportunities for observation give weight to their opinions, do not regard the disease as contagious in the strict sense of the word. During the past twenty-four years I have been almost uninterruptedly connected with large general hospitals, and during that time have had a large number of cases of typhoid fever under my care, and a still larger number more or less under my observation. During all this time I have never known but one case to originate within a hospital, and that occurred in a servant whose duties did not bring her in immediate contact with the sick. Murchison's experience with a much larger number of cases has been very similar. In twenty-three years, in which 5988 cases were treated in the London Fever Hospital, only 17 residents contracted the disease, and most of these had no personal contact with the sick. Liebermeister asserts that he has never known a case to originate in a hospital from direct contagion. When such cases appeared to have occurred, they could generally be traced, he says, to some defective sanitary condition of the hospital.