11 Quoted by Trousseau, Archives Générales, 1826.
The progress in pathology which observers were making was temporarily impeded about this time by the fact that while typhoid fever was of frequent occurrence in Paris, typhus fever was comparatively rarely met with and had not been epidemic there for several years. Bretonneau, Louis,12 Chomel, and indeed the greater number of contemporary French physicians, therefore fell into the error of supposing that the fever which was then common in England was identical with that which they were describing, while the English physicians of the period, with but few exceptions, contended with equal strenuousness that there was but one form of continued fever, and that this was very seldom associated with disease of the intestines. In the second edition of his work Louis abandoned his former opinion, and admitted that the typhus fever of the English was a very different disease from that which formed the subject of his treatise; but the confusion which existed in England in regard to this disease was not completely dispelled until the appearance in 1849 and the following two years of several papers on this subject by Sir William Jenner,13 in which it was conclusively demonstrated that typhoid and typhus fevers were separate and distinct diseases. In Germany, however, the non-identity of these diseases was recognized as early as 1810. Murchison says that the names by which they are still generally known in that country, typhus exanthematicus and typhus abdominalis, were given to them not long after.
12 Researches Anatomiques, Pathologiques et Therapeutiques sur la Maladie connue sur les Noms de gastro-entente, etc., par P. C. A. Louis, Paris, 1829.
13 Med. Chir. Trans., vol. xxxiii.; Edinburgh Monthly Jour. of Med. Sci., vols. ix. and x., 1849-50; and Med. Times, vols. xx., xxi., xxii., xxxiii., 1849-51.
The contributions made by American physicians to the knowledge of typhoid fever have been both numerous and important. In 1824 it was described by Nathan Smith14 under the name of typhus fever of New England, and in 1833, E. Hale, Jr.,15 of Boston, published in the Medical Magazine for December an account of three dissections of persons considered by him to have died of the disease. In reference to these cases, Bartlett16 says that if the diagnosis could be looked upon as certain and positive they would constitute the first published examples of intestinal lesion in New England. In February, 1835, William S. Gerhard of Philadelphia, who was then under the impression that the two diseases were identical, reported two cases under the name of typhus fever, the symptoms and post-mortem appearances of which he showed differed in no respect from those he had been accustomed to see in the cases of typhoid fever he had observed with Louis during his studies in Paris. The year after Gerhard had, however, the opportunity of observing an epidemic of true typhus fever, and was at once struck with the difference between the symptoms of the cases which then fell under his care and of those he had seen in Paris. In an admirable paper which appeared in the numbers of the American Journal of the Medical Sciences for February and August, 1837, he points out very clearly the differential diagnosis between the two diseases. He particularly insisted on the marked difference between the petechial eruption of typhus and the rose-colored eruption of typhoid fever. He showed that the latter disease was invariably associated with enlargement and ulceration of Peyer's patches and with enlargement of the mesenteric glands, and that these conditions were never presented in the former. He also fully recognized the fact that typhus fever was eminently contagious, while, on the other hand, he was fully aware that typhoid fever was not contagious under ordinary circumstances, "although in some epidemics," he says, "we have strong reason to believe it becomes so." The appearance of this paper marks an epoch in the history of typhoid fever. Murchison, when speaking of it, says that to Gerhard, and Pennock (who was associated with Gerhard in his observations) certainly belongs the credit of first clearly establishing the most important points of distinction between this disease and typhus fever, and M. Valleix alludes to it in terms equally complimentary. It is undoubtedly owing to it, more than to any other cause, that the differential diagnosis of these two diseases was perfectly understood by the great body of the profession in this country long before the question of the relation which they bore to each other was definitely settled in Great Britain,17 or even in France.
14 Medical and Surgical Memoirs, Baltimore, 1831.
15 Observations on the Typhoid Fever of New England, Boston, 1839.
16 The History, Diagnosis, and Treatment of the Fevers of the United States, 1842.
17 The honor of having first clearly pointed out the distinguishing characters of typhoid and typhus fevers has been recently claimed for Sir William Jenner, but, as we have seen above, his papers on this subject were not published until thirteen years after that of Gerhard.
Bartlett gave in the Medical Magazine, June, 1835, a short account of the entero-mesenteric alterations in five cases of unequivocal typhoid fever, which alterations, he said, corresponded exactly to those described by Louis. In the same year, James Jackson, Jr., of Boston, published an account of the intestinal lesions observed by him in cases during the years 1830, 1833, and 1834; and again in a Report of Typhoid Fever, communicated to the Massachusetts Medical Society in June, 1838, says that the alterations of Peyer's patches had been noticed at the Massachusetts General Hospital previous to 1833 in cases which were carefully examined. In 1840, Shattuck of Boston published in the American Medical Examiner an account of some cases of typhoid and typhus fever which he had observed at the London Fever Hospital during the previous year. In this paper, which had been already communicated to the Medical Society of Observation of Paris, and which had unquestionably exerted a marked influence upon medical thought there, he pointed out very fully the distinguishing characteristics of each disease. In 1842, Dr. Bartlett issued the first edition of his work on The History, Diagnosis, and Treatment of the Fevers of the United States, which contains very full descriptions of both of these diseases, and of the means by which they may be distinguished from each other. Since then there have been numerous additions in this country to the literature of typhoid fever, among the most important of which may be mentioned the chapter on the disease in the respective works on The Practice of Medicine by Professors Wood and Flint, the article on typho-malarial fever in the Transactions of the International Medical Congress of 1876, and the article in the work on The Continued Fevers, by James C. Wilson. Abroad, the medical press has been no less active. Within the last twenty or thirty years Jaccoud and Trousseau in France, Liebermeister and Hirsch in Germany, and Tweedie and Cayley in England, have all made important additions to our knowledge of the disease. To the late Dr. Murchison18 of London, however, is justly due the honor of having produced the best treatise on typhoid fever in any language, and the writer cheerfully acknowledges that he has drawn largely upon it for the material of the present article.