ENTERIC FEVER.

Auckland Star, Volume XXXI, Issue 124, 26 May 1900, Page 2 (Supplement)

ENTERIC FEVER.

How long this disease has existed aud attacked mankind is not known. The history of it was very meagre tilt the end of the second decade of this century.' The more systematic examination of dead bodies for the study ot j the morbid conditions which occurred about this time led to the discovery by French physicians than an ulceration !of the intestine was present in "typhus fever." Bretonneau, of Tours, showed that the ulcers were always located on certain parts of the intestine known as "Fever's Patches," which have a structure resembling that of the tonsil. These ulcers wore such a t«nstan'L phenomenon in their cases that the French physicians assumed that they had at last discovered something which was. characteristic ot typhus fever, and had the same relation to it that the pustules of smallipox 'have to that disease. An epidemic was raging in Britain, also of typhus or jail fever, but examination of the bodies after death revealed no intestinal ulceration, and hence it was contended by the English and Scotch physicians that there was no intestinal lesion characteristic of typhus fever. For some time there continued to be misconception; but, gradually, between 183(5 and 1839, it became plain that there were two distinct diseases—one with an intestinal Jesion (enteric fever), which at that time predominated in Paris, while, tha other (typhus) with no such lesion, was more prevalent in the United Kingdom. Dr. H. P. Stewart studied cases in Glasgow and Paris, and declared that the differences between the diseases were "so marked as to defy misconception, and to enable the observer to form with the utmost precision the diagnosis of the nature of the disease and the lesions to be revealed by dissection." Many leading- men still did not believe, and the controversy was not finally set at rest till Sir William Jenmer (only lately deceased) pubished a series of researches which he had made at the London Fever Hospital in 1849-51. When wo. remember that even now many mistakes are made between Typhus and Enteric in cities where* they both occur, and that now we have the assistance of the thermometer which plays a more important part in the diagnosis of this than of any of the epidemic fevers, we need not wonder that, they were confounded. (Typhus fever is now uncommon, except in the largest of the old cities—Lon« don, Dublin, Glasgow, Edinburgh, and occasionally there is an epidemic in the Hebrides, where the conditions of life are very different). Bretonneau proposed to call the disease "dothienenterie," from the Greek words dothien meaning a pustule, and enteron intestine. It was unfortunate that lie chose so. long a name, for although there was much to commend it, even the immense influence of his pupil Trousseau was not sufficient to give it a vogue, and it was open to Louis, a famous physician of Paris, who introduced the stethoscope and wrote on consumption, to introduce the name "typhoide." For several reasons it was a misfortune that the name was accepted. It was already used to describe a condition into which typhus patients get. a condition in which dulling or fogging' of the intellect is a leading feature, and it is derived from tupho.s. (smoke) and eidos (like). An even more serious objection was its close resemblance to "typhus," for they have often, we might almost, say usually, been considered synonymous by the public and used indifferently. We have headed this article "Enteric Fever," because it has become the recognised* name in this country, although the French .still call it typhoide, while the Germans call it typhus, with or without a qualifying adjective abdominails.. They also call it ileo-typhus. A very favourite name in this country was "gastric fever," aud iwhen the diagnosis was uncertain, ' "low fever." From what we have said above, Aye hope our readers will not only grasp the name of this disease, but also the reason why typhoid has been given up. Enteric fever occurs in epidemics, but it is not so obviously infectious as many other epidemic diseases. Ladysmith is a, ease in point. Here it has occurred in an 'epidemic, but it may be difficult to trace the connection between the individual cases. This is not scf difficult now since we know the cause of the disease and how it | spreads, but there was formerly so i little satisfactory proof available that I not a few of the most advanced authl orit ies on the disease, at the head of j whom was Dr. Murchison, who wrote the classic treatise on this disease, be- ; lieved it arose de novo, that is from !no previous case. We cannot always ! trace the source of solitary cases, but lit is seldom that a real epidemic visi-tation-remains unexplained, and it ia ■ very probable that in the case of Ladysmith a contaminated water supply aeeounted for the outbreak. | With- us water supplies are only rarely to blame, unless in the smaller towns —Maidstone 'was a. notable instance —but milk is a serious means of conveyance. A small contamination of milk is serious, for it is a very good culture medium, and the bacilli grow freely in it, especially while it is warm. Rigorous inspection of the dairies from which a town supply of milk is drawn is therefore highly desirable. —"Mcdi ico" in the "Birmingham Post."