Spectrums of Infectious Disease

Scant attention was paid to graded degrees of severity of infectious diseases in the past. Study was impeded by undeveloped knowledge, lack of exact methods of diagnosis, rigid clinical criteria of the "typical" case, and, during epidemics, by the pressure of the emergency. Inapparent infections were undetectable, and victims of mild attacks usually were ignored or regarded as having some other ailment. After 1868, for example, according to Wunderlich's dictum, typhoid was not typhoid unless fever reached 39.5 C (103.1 F) between the fourth and sixth days. During an epidemic of cholera as late as 1944, victims not dehydrated or in a shock-like state were not regarded as having cholera. Yet brief typhoid was known to Louis, and Koch had described mild cholera in 1892. Sydenham recognized trivial smallpox, in 1676; mild yellow fever was observed by Nott, in 1848, and Ghon, in 1916, demonstrated specific pulmonary lesions as sequels