disease; also the fact that the epidemic extension of the disease depends upon external conditions relating to temperature, altitude, rainfall, etc. It was a well-establislied fact that the disease is arrested by cold weather and does not prevail in northern latitudes or at considerable altitudes. But diseases which are directly transmitted from man to man by personal contact have no such limitations. The alternate theory took account of the above-mentioned facts and assumed that the disease was indirectly transmitted from the sick to the well, as is the case in typhoid fever and cholera, and that its germ was capable of development external to the human body when conditions were favorable. These conditions were believed to be a certain elevation of temperature, the presence of moisture and suitable organic pabulum (filth) for the development of the germ. The two first-mentioned conditions were known to be essential, the third was a subject of controversy.
Yellow fever epidemics do not occur in the winter months in the temperate zone and they do not occur in arid regions. As epidemics have frequently prevailed in sea-coast cities known to be in an insanitary condition, it has been generally assumed that the presence of decomposing organic material is favorable for the development of an epidemic and that, like typhoid fever and cholera, yellow fever is a 'filth disease.' Opposed to this view, however, is the fact that epidemics have frequently occurred in localities (e. g., at military posts) where no local insanitary conditions were to be found. Moreover, there are marked differences in regard to the transmission of the recognized filth diseases—typhoid fever and cholera—and yellow fever. The first-mentioned diseases are largely propagated by means of a contaminated water supply, whereas there is no evidence that yellow fever is ever communicated in this way. Typhoid fever and cholera prevail in all parts of the world and may prevail at any season of the year, although cholera, as a rule, is a disease of the summer months. On the other hand, yellow fever has a very restricted area of prevalence and is essentially a disease of seaboard cities and of warm climates. Evidently neither of the theories referred to accounts for all of the observed facts with reference to the endemic prevalence and epidemic extension of the disease under consideration.
Having for years given much thought to this subject, I became some time since impressed with the view that probably in yellow fever, as in the malarial fevers, there is an 'intermediate host.' I therefore suggested to Dr. Reed, president of the board[1] appointed upon my recommendation for the study of this disease in the Island of Cuba, that he should give special attention to the possibility of transmission by some
- ↑ The members of the board were: Major Walter Reed, Surgeon U. S. A.; Dr. James Carroll, Contract Surgeon U. S. A.; Dr. A. Agramonte, Contract Surgeon U. S. A., and Dr. Jesse W. Lazear, Contract Surgeon U. S. A.
