A RETROSPECTIVE GLANCE.
1
1664 A RETROSPECTIVE GLANCE.—THE BOWEL LESION OF TYPHOID ]j’EVEH. or temporary nuisance would not be interfered with. I " It was not necessary that substantial damage should actually have been done, but the court would inter- fere if it could be proved that substantial injury would be caused unless the nuisance that was complained of was stopped." The unfortunate orchids were put out of court altogether, as, "the case ought not to be tested by the effect of the smoke on delicate exotics, but by its effect on an ordinary garden." He was satisfied that in this case the smoke was such that it would cause injury to an ordinary garden, so that the plaintiff was entitled to bring the action, the defendant must pay the costs, and if the occasion should arise the plaintiff could apply for an injunction. It really seems easier to obtain protection from smoke for the plants in a garden if they are only "ordinary," than for the people of some parts of our large towns who are apparently somewhat in the position of the orchids. It would be interesting to know if the Vice-Chancellor would look on human visitors from a tropical clime in the light of delicate exotics, and deny them protection because they were not " ordinary." It is said that in the well-known Crumpsall case Messrs. Levinstein are appealing against the decision by which they were fined at the last hearing of the case. ___ A RETROSPECTIVE GLANCE. THE Westnaircste Revierv of May, 1832, contains an article on " Improvements in Medicine and Surgery " which may be commended to the attention of the rising medical generation. "It is a fact capable of demonstration," says the reviewer of 68 years ago, " that since the healing art reached that point of cultivation which entitled it to the name of science disease has been gradually decreasing both in frequency and fatality. And it is equally capable of proof that the degree of perfection with which anatomy has been studied at any successive periods may be safely taken as the rule by which the progress of all the other branches of the science may be ascertained." Rejecting Sydenham’s dictum as to the uselessness of searching into the bowels of dead and living creatures ...... to find out the seeds of disease," the reviewer emphatically endorses "Baillie’s assertion that ’ the dead body is that great basis on which we are to build the knowledge that is to guide us in distributing life and health to our fellow creatures’" ; and then proceeds to quote the statistics of Sir William Petty " who died," he informs his readers in a parenthesis, "about 150 years since." According to Petty, the proportion of deaths to cures in St. Bartholomew’s and St. Thomas’s Hospitals was in his time one to seven, whereas in 1741 the corresponding mortality had diminished to one in 10, in 1780 to one in 14, and in 1813 to one in 16. Finally, exclaims the reviewer, "out of 12,494 patients treated in St. Thomas’s Hospital 259 only were buried, or one in 48." Some remarks of His Royal Highness the Duke of Sussex are next quoted, among them being the statement " that comparing the value of life as it is now calculated to what it was 100 years ago it has absolutely doubled." The Royal Duke then went on to expose how at one time I the entire half of our population were destroyed by one disease-small-pox." Typhus fever used to "slay one out of every three whom it attacked," but at the time of writing the mortality did not amount to one in 16. Measles, scarlet fever, whooping.cough, and consumption were no longer regarded with extreme terror. From 1799 to 1808 about 27 per cent. of those who became ill with consumption died, but during the succeeding lustrum the mortality fell to 23 per cent., and from 1813 to 1822 it still further decreased to 22 per cent. "As anatomy was more attended to," continues the reviewer, " surgery proportionally advanced....... The extreme clumsiness and cruelty with which operations used to be performed could scarcely be credited. Thus, Fabricius of Aquapendente, preceptor of the immortal Harvey, describes what he considered was an improved and easy operation. ° If it be a moveable tumour I cut it away with a red-hot knife that sears as it cuts ; but if it be adherent to the chest I cut it, without bleeding or pain, with a wooden or horn knife soaked in aqua-fortis, with which having cut the skin I dig out the rest with my fingers."’ " It would be interesting to know with what object the soaking in nitric acid was performed ; did the illustrious surgeon thus prefigure the advent of antisepticism It is a pity he does not say whether he soaked his fingers as well. A concluding observation by the reviewer seems to indicate an amount of knowledge on the part of a certain class of irregular practitioners with which it is not at the present day credited: "It is little more than 50 years ago when Mr. Sharpe, one of the most eminent surgeons of London, denied the possibility of the thigh. bone being dislocated at the hip-joint, an accident which occurs daily and which the merest bone-setter in the kingdom can now detect." The final paragraph of this instructive article is noteworthy: "But it were a task equally difficult and unnecessary to enumerate one-tenth of ’the achievements of modern surgery (te7apus 1832) ; and it were superfluous to add that it is to anatomy, and to anatomy alone, that all improvements in this department can be traced." After three-score and ten more years have passed what will be the opinion of our successors regarding the achievements of modern surgery, tempus 1900 2 THE BOWEL LESION OF TYPHOID FEVER. IN another column we publish an interesting article by Dr. T. J. Maclagan with the above title. The writer describes in graphic language the changes brought about in a Peyer’s patch during an attack of typhoid fever. Now that in every infectious disease we expect to find a micro-organism in direct causal relationship with that disease there is a tendency to consider that the pathogenic organism is the sole cause of the lesions characteristic of the malady. Thus in pulmonary tuberculosis the bacillus of tubercle naturally holds the most prominent place, but we must not forget that other micro-organisms are respon- sible for the very active pulmonary disintegration which frequently occurs. So Dr. Maclagan points out that in typhoid fever elements other than the typhoid bacillus have to be contended against. The structures in which the patho- genic micro-organism directs its specific effects are the salivary and agminated glands situated in the submucous coat of the small intestine, and certain changes are thereby produced which essentially consist in proliferation of their cellular and granular contents, with consequent swelling and hardening of the glands. Further, this inflammation is generally sufficiently severe to cause gangrene and slough- ing of the affected glands. Dr. Maclagan explains that the direct action of the typhoid bacillus is limited to the glands of the submucous coat and that it has no direct action on the mucous, muscular, or peritoneal coats. But the sloughing process which destroys the glands necessarily also destroys the mucous membrane situated over them. With the process of sloughing and suppuration there come into play other and new morbid agencies and the various forms of cocci associated with these processes. To these new agencies, rather than to the typhoid bacillus, Dr. Maclagan attributes all the more serious complications and all the formidable symptoms, general as well as local, which are apt to show themselves during the third and fourth weeks of the disease. We believe this view of the pathology and bacteriology of typhoid fever to be a sound one, and, as already pointed out, it is analogous to what is found in other diseases. It would likewise lend support to the treatment of typhoid fever by
Transcript of A RETROSPECTIVE GLANCE.
1664 A RETROSPECTIVE GLANCE.—THE BOWEL LESION OF TYPHOID ]j’EVEH.
or temporary nuisance would not be interfered with. I
" It was not necessary that substantial damage shouldactually have been done, but the court would inter-fere if it could be proved that substantial injury wouldbe caused unless the nuisance that was complained ofwas stopped." The unfortunate orchids were put out ofcourt altogether, as, "the case ought not to be tested bythe effect of the smoke on delicate exotics, but by its effecton an ordinary garden." He was satisfied that in this casethe smoke was such that it would cause injury to anordinary garden, so that the plaintiff was entitled to bringthe action, the defendant must pay the costs, and if theoccasion should arise the plaintiff could apply for an
injunction. It really seems easier to obtain protection fromsmoke for the plants in a garden if they are only "ordinary,"than for the people of some parts of our large towns whoare apparently somewhat in the position of the orchids. It
would be interesting to know if the Vice-Chancellor wouldlook on human visitors from a tropical clime in the light ofdelicate exotics, and deny them protection because theywere not " ordinary." It is said that in the well-known
Crumpsall case Messrs. Levinstein are appealing againstthe decision by which they were fined at the last hearing ofthe case.
___
A RETROSPECTIVE GLANCE.
THE Westnaircste Revierv of May, 1832, contains an articleon " Improvements in Medicine and Surgery " which may becommended to the attention of the rising medical generation."It is a fact capable of demonstration," says the reviewerof 68 years ago, " that since the healing art reached thatpoint of cultivation which entitled it to the name of sciencedisease has been gradually decreasing both in frequency andfatality. And it is equally capable of proof that the degreeof perfection with which anatomy has been studied at anysuccessive periods may be safely taken as the rule by whichthe progress of all the other branches of the science
may be ascertained." Rejecting Sydenham’s dictum as
to the uselessness of searching into the bowels of dead andliving creatures ...... to find out the seeds of disease," thereviewer emphatically endorses "Baillie’s assertion that
’ the dead body is that great basis on which we are to buildthe knowledge that is to guide us in distributing life andhealth to our fellow creatures’" ; and then proceeds to quotethe statistics of Sir William Petty " who died," he informshis readers in a parenthesis, "about 150 years since."
According to Petty, the proportion of deaths to cures inSt. Bartholomew’s and St. Thomas’s Hospitals was in histime one to seven, whereas in 1741 the correspondingmortality had diminished to one in 10, in 1780 to one in 14,and in 1813 to one in 16. Finally, exclaims the reviewer,"out of 12,494 patients treated in St. Thomas’s Hospital259 only were buried, or one in 48." Some remarks of His
Royal Highness the Duke of Sussex are next quoted, amongthem being the statement " that comparing the value of lifeas it is now calculated to what it was 100 years ago it has
absolutely doubled." The Royal Duke then went on to
expose how at one time I the entire half of our population
were destroyed by one disease-small-pox." Typhus feverused to "slay one out of every three whom it attacked,"but at the time of writing the mortality did not amount toone in 16. Measles, scarlet fever, whooping.cough, andconsumption were no longer regarded with extreme terror.From 1799 to 1808 about 27 per cent. of those who becameill with consumption died, but during the succeedinglustrum the mortality fell to 23 per cent., and from1813 to 1822 it still further decreased to 22 per cent."As anatomy was more attended to," continues the
reviewer, " surgery proportionally advanced....... Theextreme clumsiness and cruelty with which operations usedto be performed could scarcely be credited. Thus, Fabricius
of Aquapendente, preceptor of the immortal Harvey,describes what he considered was an improved and easyoperation. ° If it be a moveable tumour I cut it away witha red-hot knife that sears as it cuts ; but if it be adherentto the chest I cut it, without bleeding or pain, with awooden or horn knife soaked in aqua-fortis, with whichhaving cut the skin I dig out the rest with my fingers."’ "It would be interesting to know with what object the
soaking in nitric acid was performed ; did the illustrious
surgeon thus prefigure the advent of antisepticism It is apity he does not say whether he soaked his fingers as
well. A concluding observation by the reviewer seems toindicate an amount of knowledge on the part of a
certain class of irregular practitioners with which it is notat the present day credited: "It is little more than 50
years ago when Mr. Sharpe, one of the most eminent
surgeons of London, denied the possibility of the thigh.bone being dislocated at the hip-joint, an accident whichoccurs daily and which the merest bone-setter in the
kingdom can now detect." The final paragraph of thisinstructive article is noteworthy: "But it were a task equallydifficult and unnecessary to enumerate one-tenth of ’theachievements of modern surgery (te7apus 1832) ; and it weresuperfluous to add that it is to anatomy, and to anatomyalone, that all improvements in this department can betraced." After three-score and ten more years have passedwhat will be the opinion of our successors regarding theachievements of modern surgery, tempus 1900 2
THE BOWEL LESION OF TYPHOID FEVER.
IN another column we publish an interesting article by Dr.T. J. Maclagan with the above title. The writer describesin graphic language the changes brought about in a Peyer’spatch during an attack of typhoid fever. Now that in everyinfectious disease we expect to find a micro-organism in
direct causal relationship with that disease there is a
tendency to consider that the pathogenic organism is thesole cause of the lesions characteristic of the malady.Thus in pulmonary tuberculosis the bacillus of tubercle
naturally holds the most prominent place, but we
must not forget that other micro-organisms are respon-sible for the very active pulmonary disintegration which
frequently occurs. So Dr. Maclagan points out that in
typhoid fever elements other than the typhoid bacillus haveto be contended against. The structures in which the patho-genic micro-organism directs its specific effects are the
salivary and agminated glands situated in the submucouscoat of the small intestine, and certain changes are therebyproduced which essentially consist in proliferation of theircellular and granular contents, with consequent swelling andhardening of the glands. Further, this inflammation is
generally sufficiently severe to cause gangrene and slough-ing of the affected glands. Dr. Maclagan explainsthat the direct action of the typhoid bacillus is limitedto the glands of the submucous coat and that it hasno direct action on the mucous, muscular, or peritonealcoats. But the sloughing process which destroys the
glands necessarily also destroys the mucous membranesituated over them. With the process of sloughingand suppuration there come into play other and newmorbid agencies and the various forms of cocci associatedwith these processes. To these new agencies, rather than tothe typhoid bacillus, Dr. Maclagan attributes all the moreserious complications and all the formidable symptoms,general as well as local, which are apt to show themselvesduring the third and fourth weeks of the disease. Webelieve this view of the pathology and bacteriology of
typhoid fever to be a sound one, and, as already pointed out,it is analogous to what is found in other diseases. It wouldlikewise lend support to the treatment of typhoid fever by
