EARLY STUDIES OF THE DISEASE NOW UNIVERSALLY CALLED TYPHOID FEVER

Up to the year 1829 the disease now universally called “typhoid fever” was known by a great variety of names, all of them more or less objectionable and therefore not acceptable to the majority of physicians. Here are a few specimens of these terms: “gastritis” or “gastro-enteritis”; “enteric fever”; “slow nervous fever”; “gastroentero-cephalitis”; “abdominal typhus”; “pathogenic fever,” etc. It is only in the last-mentioned name that we find evidence of an attempt—only a very feeble attempt, it is true—to suggest some connection between the term proposed and the real cause of the disease. Chomel, in 1834, very quickly disposed of the first two names suggested when he wrote: “At the present time no physician who is a careful observer of disease and who at the same time is well versed in pathological anatomy, looks upon typhoid fever as a gastritis or a gastro-enteritis.” At about the same time Philippe Pinel, the distinguished author of the work entitled “Nosographie Philosophique,” made the following statement with regard to typhoid fever: “In this disease one cannot fail to observe that there exists, toward the end of the small intestine, a violent inflammation of the mucous membrane.” To go back farther still in the history of medicine I will mention here the fact that Galen attributed this and other epidemic fevers to the drinking of infected water. Huxham and Pringle, two of the best English authorities on fevers, frequently mention, as a cause of typhoid fever, the drinking of polluted water in which are contained decomposing animal matters. So far as I am able to ascertain, however, Johann Peter Frank was the first to throw doubt upon the correctness of this mode of causation, or at least upon the correctness of the form in which the statement is made. Putridity alone, he says, does not satisfactorily explain the characteristic features of the disease. “The cause of these nervous fevers,” he adds, “is not to be found in putrid matter but rather in some principle, or primary element, which easily combines with it,—an element the nature of which is unknown to us.” Putrid matter, then, was recognized by Frank as being simply the vehicle of the cause of the disease (viz., a special contagium vivum). Budd, in 1856, held very much the same view; and Murchison, in 1857, agreed in the main with Budd.

The next suggestion of a new name for typhoid fever came from Bretonneau, of Tours, France; his proposition being that the disease should be called “DothiÉnentÉrite” (from d?????, the Greek word for pimple, and ??te???, intestine). Certain authors attributed the associated fever to these pimple-like lesions in the small intestine, but Bretonneau held that the latter are the products of an infection and not the cause of the fever; and that view has been universally accepted as correct ever since his time. This new term for typhoid fever, however, was not favorably received, and was very soon forgotten. On the other hand, the expression “typhoid fever” (from t?f??, stupor, and e?d??, form), which simply described the most noteworthy feature of the disease, was promptly adopted. Charles A. P. Louis,^[24] Chief of Clinic at the École de MÉdecine of Paris, and Member of the AcadÉmie Royale de MÉdecine, to whom we are indebted for the final settlement of this troublesome question, gives the following brief account of the considerations which led him to urge the final acceptance of the term “typhoid fever”: “After seeking carefully for a term that would express the anatomical features of this disease, without jarring too decidedly upon the ear, as ‘dothiÉnentÉrite’ does, and having failed to discover any better expression than ‘typhoid fever,’ I finally decided to employ it in preference to all others.” And since that time no physician has succeeded in supplanting it with a term more acceptable to the Profession. As to the real underlying cause of typhoid fever I shall have nothing to say, as this is a matter which belongs strictly to the domain of modern medicine; and I have no wish to trespass upon the territory of the writer of this most important section of the history of medicine.

As to the contagiousness of typhoid fever Louis states that, out of 117 cases which he had observed, there were only three that might be imputed to contagion.

A few words more concerning Charles A. P. Louis, to whom I have already referred briefly in connection with the subject of selecting a suitable name for typhoid fever. Marshall Hall, the famous English physician, characterizes him as the greatest pathologist of any nation or of any age. In another place he says:—

Monsieur Louis is the Bacon of Medicine; he has taught us how to observe, and how to deduce important laws from the facts observed.... Monsieur Louis is a man of such talent, labour, exactness, truth, and probity, as I never met with in any other man. His labours I shall consider as the chief ornament of these lectures, and my chief claim to your consideration.

In still another place Marshall Hall quotes Louis’ own account of the early years of his professional career, as follows:—

After having practised as a physician in a foreign country, I returned to France, at the age of thirty-three, determined to give myself up to the observation of disease; and, in order to obtain my end more effectually, I resolved to forego all other employment. I pursued this course for nearly seven years; in other words, during that time I devoted myself exclusively to the observation of all the cases admitted into St. John’s and St. Joseph’s wards at the hospital of La CharitÉ. Three years elapsed before I ventured to publish, at the request of a friend, my first memoir, on the perforation of the small intestines; my object being to observe for myself, and not to describe what I might have observed.