Distribution and Incidence

William Osier once wrote that typhomalarial fever existed "in the minds of doctors but not in the bodies of patients." If so, it existed in the minds of many American doctors in the South, Midwest, and western regions of the country as well as in the minds of military and other European physicians practicing in the unsanitary, malarious regions of the globe, particularly the Mediterranean, British India, and some areas of China. It was primarily an Anglo-American phenomenon, although there are a few reports from southern Europe, which indicate that the possibility of the diagnosis was at least considered.

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