66 TYPHOID FEVER 



are discharged; now, nature sinks apace; the pulse may be said to tremble and 

 flutter rather than to beat; the sick man becomes quite insensible; and the 

 delirium ends in a profound coma; and that soon in an eternal sleep. 



Up to the nineteenth century all the continued fevers with delirium 

 were known under the general name "typhus," which means smoky 

 or cloudy, and refers to the mental state. Early in the seventeenth 

 century some of the more observant physicians began to suspect that 

 two quite distinct diseases were included under the diagnosis of 

 typhus and on this point there grew up a discussion which continued 

 for two hundred years. In order to gain knowledge to settle this 

 question, necropsies were frequently resorted to and most minute and 

 exact studies of the lesions were made. In a medical way the dispute 

 became partially at least an international one. French physicians, led 

 especially by Bretonneau of Tours, held that in their necropsies they 

 found, quite usually, lesions, inflammatory and ulcerative, in the ileum, 

 while British physicians for the most part failed to find such changes. 



The great clinicians of Paris in the early part of the nineteenth 

 century were Trousseau and Louis and these were earnest in present- 

 ing their views. At that time many of the brighter young medical men 

 of this country went to Paris to continue their studies. There they 

 heard the lectures and saw the necropsies. Stopping in Great Britain 

 in their visits to and from Paris, they heard lectures and saw necrop- 

 sies. In France ulcers were found in the intestines; in England they 

 were not. In this country some necropsies revealed intestinal lesions 

 while others did not. It soon became evident that there were two 

 distinct diseases, differing not only in the lesions found after death but 

 in onset, progress, and in other respects. The old name, typhus, was 

 retained for the form without intestinal lesions and the new term 

 "typhoid" given to that with such lesions. Louis selected the new 

 name, and in giving it he said: "I have long searched for a word 

 to express the anatomical character of this disease which would not 

 be disagreeable to the ear, and having failed to find such an one, I have 

 adopted the expression 'affection typhoide/ as being at least free from 

 inconveniences." Bretonneau had used the designation "dothin- 

 enterie" meaning pustule in the intestine. The word "typhoid" is 

 unfortunate and not so good as the English designation "Enteric 



