_SIR WILLIAM JENNER, BUDD, MURCHISON, AND TYPHOID FEVER._
In no department of medical knowledge has recent progress been more
marked than in the discrimination and the tracing of the natural
history of the diseases known as zymotic: and no man takes higher
rank in this department of investigation than Sir WILLIAM JENNER.
He was born at Chatham, January 30, 1815, being the son of Mr. John
Jenner, and educated at University College, London. After qualifying
as a general practitioner, he commenced practice and obtained the
appointment of Surgeon-Accoucheur to the Royal Maternity Charity.
Before long he graduated M.D. at London University (1844), and
retired from general practice. His studies in pathology became more
and more extensive, and his merits were so far recognised that in
1849 he was elected Professor of Pathological Anatomy to University
College, and Assistant-Physician to University College Hospital.
For some years Dr. Jenner had been assiduously studying in the London
Fever Hospital, seeking to make a straight path through the many
knotty questions then, in debate. In April 1849 he commenced the
publication, in the _Monthly Journal of Medical Science_, of his
classic paper on “Typhoid and Typhus Fevers, an attempt to determine
the question of their identity or non-identity, by an analysis of
the symptoms, and of the appearances found after death in sixty-six
fatal cases of continued fever, observed at the London Fever Hospital
from January 1847 to February 1849.” In this he states that “with
few exceptions, British physicians have laboured to prove that
typhoid and typhus fevers are identical. The results obtained by this
analysis justify the assertion that they are essentially distinct
diseases.... For two years, in distinguishing the two diseases by
the eruption alone not a single error has been made, so far as could
be proved by examination after death of the fatal cases, or by the
progress of the non-fatal cases after their diagnosis was recorded.”
The history of previous investigations and the fluctuations of
opinion are excellently given by Dr. Murchison in his great work on
the “Continued Fevers of Great Britain,” 1862, 2d ed. 1873. Dr. H. C.
Lombard of Geneva appears to have been the first to state positively
(in 1836) that “there were two distinct and separate fevers in Great
Britain; one of them identical with the contagious typhus, the other
a sporadic disease, identical with the typhoid fever of the French.”
He failed, however, to point out the distinctive eruptions and other
characteristics of the two fevers. At the same period Drs. Gerhard
and Pennock in Philadelphia arrived at more definite conclusions, and
distinguished the typhus of Philadelphia as being the same as British
typhus, the old gaol, camp, and ship fever, so direfully contagious
and fatal; while certain intestinal phenomena were invariably
found in the other or typhoid fever, which was rarely contagious.
The characteristic eruptions and many of the symptoms were also
accurately discriminated. These observers were followed by others who
with more or less success and emphasis insisted on the same views.
Among these were Drs. H. C. Barlow and A. P. Stewart, both of whom
read important papers on the subject before the Parisian Medical
Society in 1840. In 1841 the celebrated Louis in the second edition
of his great work on typhoid fever accepted the view that the English
typhus was very distinct from the fever which he had so largely
elucidated. Nevertheless many physicians of authority strongly
maintained their identity, and the majority of the medical schools
taught this doctrine, which could not fail to retard progress. It is
obvious how much uncertain and injurious treatment must have existed
for a long period owing to the confusion of these two diseases.
In his series of papers published in 1849 and 1850 Dr. Jenner
confirmed and extended the distinctions between the symptoms of the
two fevers, comparing the selected cases most minutely as regarded
previous health, complexion, sex, age, mode of attack, duration,
eruption, expression during disease, manner, hue of face, presence
of headache, delirium, loss of muscular power, sensation, appearance
of the tongue, suffering of pain, appetite, thirst, pulse, cough,
and lung symptoms, and many other particulars, and detailed most
carefully the _post mortem_ appearances of the diseased action in
every organ.
As regards the age of patients, he showed by calculation that typhoid
usually attacked much younger patients than typhus, the average
age of his cases of the one being 22 years, of the other 42 years.
In typhus, death took place on the average on the fourteenth day,
while in typhoid the average was the thirty-second day of residence
in the hospital. The rose rash of typhoid, disappearing completely
on pressure, resuming the original appearance on the withdrawal of
pressure, was clearly discriminated from the mulberry rash of typhus.
His _post mortem_ observations may be considered to have given the
death-blow to the idea that typhoid was merely typhus fever with
abdominal complications. In closing the series of papers (April
1850) Dr. Jenner remarked, as to the suggestion that he had drawn
general conclusions from a too limited number of facts, “A few facts,
impartially observed, minutely recorded, and carefully analysed,
are, I believe, more likely to give correct results than a multitude
of general observations; and moreover, I believe most men would be
astonished if they had in numbers all the cases of any given disease
they had ever seen, yet concerning which they have generalised. The
method I have adopted—however prolix it may be, however difficult
to conform to, however tedious the details into which it leads—has
this advantage, that if the observer be honest, and capable of noting
what is before him, thinking men may judge of the value of his facts,
the force of his reasoning, and the correctness of his conclusion;
whereas general observations, while they are totally incapable of
proving anything, are exposed to all the fallacies of definite
statements, because the one, like the other, rests ultimately on the
accuracy of the facts observed. If the observations on which any
reasoning is founded be erroneous, no cloaking of those observations
in general terms can render the conclusions correct. It has been
objected to definite numerical statements that they mislead the
reader by an _appearance_ of accuracy in cases where there has been
great inaccuracy in observation. This objection appears to me to
lie against the condition of the reader’s mind, and not against the
method.... The more complicated the problem to be solved, the more
careful ought we to be that _every_ step in its solution is made
correctly. How complex questions, such as arise in medicine, are to
be determined mentally—_i.e._, without the aid of figures—by ordinary
men, I am at a loss to conceive. Yet physicians think to solve, by
mental reveries, problems in comparison with which the most difficult
that the most renowned calculators ever answered were child’s play;
and not only do they think to solve these problems, but to carry in
their minds for years the complicated materials by which they are to
be solved.”
Another important branch of Dr. Jenner’s inquiry dealt with the
question as to whether the specific cause of these diseases is
distinct or the same, the latter being then the preponderant
opinion. In a paper on this subject communicated to the Royal
Medical and Chirurgical Society, on December 11, 1849, he showed
that in 1847-8-9, on analysing all the cases in which two or more
fever patients came from the same house, scarcely a single instance
occurred where typhus and typhoid came at the same period from the
same house. In nearly all cases the two diseases came from quite
distinct localities. No transitional cases occurred between the two;
the rash of typhoid did not graduate into that of typhus. It was
several times observed that when a succession of cases came from the
same locality, or arose apparently from the same cause, they agreed
remarkably in symptoms or other features. Thus Dr. Jenner considered
he had definitely proved that typhus and typhoid proceeded from
perfectly distinct causes, a result which recent medical science
accepts without reserve.
Although the contributions of this distinguished physician have been
of such high worth, and his subsequent success so great in practice,
he is far from being wedded to the view that any great step forward
in medicine has been the direct result of the labours of a single
man. Long after his early papers, in addressing the British Medical
Association in 1869, Sir William Jenner said: “The silent workers
render most efficient aid, the results of their unspoken experience
confirming or refuting the published assertions of the few.” He
believes that no science has advanced more during the present epoch
than medicine, and that it has progressed equally as a practical art.
Dr. Jenner’s appointments include, among a crowd of others, those
of Physician to University College Hospital (1854), Professor
of Clinical Medicine (1857) and of the Principles and Practice
of Medicine (1862), Physician to the Hospital for Sick Children
(1852), Assistant-Physician to the Fever Hospital (1853). In 1864
he was elected Fellow of the Royal Society, and became President
of the College of Physicians in 1881. In 1861 he was appointed
Physician-Extraordinary to the Queen, and attended the Prince-Consort
in his last illness. In 1862 he became Physician-in-Ordinary to the
Queen, and has frequently attended her Majesty. He was made a baronet
in 1868, and further advanced to the dignity of a K.C.B. in 1872 for
his services during the Prince of Wales’s illness from typhoid fever.
Sir William Jenner has published eminently valuable clinical
systematic lectures in the medical journals, and a small treatise on
Diphtheria (1861). His addresses to the British Medical Association
(1869), and to the Epidemiological Society (1866), published
together, are most excellent as summaries of the modern progress of
medicine, and as pointing out the directions in which future advances
may be made. He insists most strongly on and desires most ardently
the prevention of disease, and shows a striking readiness to welcome
new discoveries.
* * * * *
Few more striking individualities have been seen among the provincial
physicians of our day than that of WILLIAM BUDD, of Clifton. He
was one of the younger sons of Mr. Samuel Budd, a successful
medical practitioner at North Tawton in Devonshire, who having
very considerable culture and foresightedness, brought up most of
his large family at home, and was ultimately enabled to introduce
seven out of nine sons to the medical profession, sending seven to
Cambridge, where five became wranglers. One of the elder brothers,
George Budd, was long Professor of Medicine at King’s College,
London, the author of an excellent treatise on Diseases of the
Liver, and a most successful London physician. William Budd was
born in September 1811; his medical studies were pursued in London,
Edinburgh, and Paris, in the latter of which cities he spent four
years. Graduating M.D. in 1838 at Edinburgh, he for some time
afterwards assisted his father in his practice at North Tawton, and
here in 1839 commenced his lifelong studies on typhoid fever, having
himself been already a sufferer by that malady. He had peculiar
advantages in this study, for he was personally acquainted with
every inhabitant of the village, and being as medical practitioner in
almost exclusive possession of the field, nearly every one who fell
ill, not only in the village itself, but over a large area around
it, came immediately under his care. At the date of the outbreak
the population of eleven or twelve hundred had been extremely
exempt from fevers. Yet there was no sewerage system; cesspools
prevailed; pig styes were close to the houses; and all conditions
of decomposition were to be found;—but fever did not arise till it
had been specifically introduced. In July 1839 the first case of
typhoid occurred, and before the beginning of November over eighty
of the inhabitants had suffered from it. Young Budd kept an accurate
and detailed record of every essential fact, and spared no pains in
tracing out all extraneous facts that he required to know. He was
extremely struck by the fact that three persons left North Tawton
after they had been infected, and all three communicated the disease
to one or more of the persons by whom they were surrounded. The
narrative which Dr. Budd gave many years afterwards, in his “Typhoid
Fever: its Nature, Mode of Spreading, and Prevention” (1873), is like
a romance for its interesting detail, though melancholy with its
tale of pain and death. He shows that there is evidently a specific
poison which breeds and multiplies in the living human body, and
that this process of breeding and multiplying constitutes the fever
itself. This essentially is its contagiousness, the communication
from body to body of the specific matter or germ, which when bred
and multiplied produces the fever. This he called the master-fact
in its history. He further believed that all the emanations from
the typhoid patient are in a certain degree infectious, but that
what is cast off from the intestine is incomparably more virulent
than anything else. Wherever no sufficient provision was made for
preventing such material from contaminating the soil and air of the
inhabited area around, notwithstanding the most spacious rooms, the
freest ventilation, and careful nursing, he found there was no real
security against the spread of the fever. The fact alleged against
Dr. Budd’s views, that typhoid is seldom taken by attendants on the
sick, does not at all militate against his teaching, for unless they
received into their system through milk, water, food, or air, some of
the specific poison of typhoid, they would certainly not suffer.
In 1842 Dr. Budd settled in Clifton, and was in 1847 elected
Physician to the Bristol Royal Infirmary. He lectured for a number
of years in the Bristol Medical School, and worked incessantly
at maturing and propagating his views on the nature and mode of
propagation of zymotic disease. He was no mere theorist, but in all
his pursuits had most practical objects in view, seeking to enforce
on his medical brethren, public authorities as well as private
persons, the urgent necessity of the most careful, well-advised,
and continuous methods of disinfection. He was in effect a great
sanitarian and champion of preventive medicine. Pure water was one of
his great panaceas. The Bristol Waterworks were among his cherished
objects of promotion and watchfulness. His remarkable clearness of
vision and strength of conviction made him somewhat impatient of
the strenuous opposition with which his views were met. For a long
period he was almost alone in his uphill fight. He did not fully put
his views before the profession till 1857-60, when he published a
series of papers in the _Lancet_, afterwards embodied in his work
on typhoid fever; but he had long before taught them in the Bristol
Medical School, and practically acted upon them himself. During the
depressing period of opposition which he encountered, almost the only
sympathy he could count on was that of the late Sir Thomas Watson,
who encouraged him greatly, believing his investigations to be of
priceless value. Cheered in this way, Budd continued to promulgate
his views, dogmatically it is true, but in a manner singularly
attractive, for he had a natural kindliness of disposition and
freedom from all jealousy. His impressive eloquence was not more
striking than his logical power, which is evident in all his works.
Asiatic cholera, when it broke out in Bristol in 1866, found William
Budd and Bristol prepared. The deaths from this destroyer in 1849
had been 1979, in 1866 they were but 29, notwithstanding that the
disease broke out very severely, and occurred in twenty-six different
localities. Budd’s preventive measures, and his stringent plans of
disinfection, proved victorious. He made the contagious diseases
of animals subjects of special study; and his conclusion was that
several of them could only be adequately dealt with by immediately
slaughtering the infected animals. This view he took in regard to the
terrible rinderpest of 1866: and his advice of “a poleaxe and a pit
of quicklime,” though at first ridiculed, had to be followed, after
great loss had taken place through not following it earlier.
Dr. Budd was elected a Fellow of the Royal Society in 1870. Besides
his famous work on typhoid fever, and many scattered contributions
to medical journals and societies, Dr. Budd was the author of the
following works, many of which are of very great value:—“Malignant
Cholera: its Mode of Propagation and its Prevention” (1849);
“Scarlet Fever and its Prevention” (1869); “The Siberian Cattle
Plague, or the Typhoid Fever of the Ox” (1865); “On Diseases which
affect Corresponding Parts of the Body in a Symmetrical Manner”
(1842); “Researches on Gout” (1855); “Cholera and Disinfection, or
Asiatic Cholera in Bristol in 1866” (1871); “Variola Ovina—Sheep’s
Smallpox—or the Laws of Contagious Epidemics Illustrated by an
Experimental Type” (1863). He was an accomplished draughtsman and
an excellent photographer, and made great use of these arts in his
researches. He was well skilled in French, German, and Italian,
and kept himself well up in Continental as well as English medical
literature. He worked with untiring energy and industry, having
a large practice extending far beyond Bristol: but the attempt to
combine this with so much original research proved too much for his
constitution. He had been originally strong, but was weakened by two
attacks of fever, and finally in 1873 his health broke down, and this
led to his finally retiring from practice and settling at Clevedon,
where he died January 9, 1880. Just previously to his retirement he
had committed to his friend Dr. Paget of Cambridge a brief summary
of the results of many years’ study of pulmonary consumption, as to
its communicability from person to person by organic germs. This was
published in the _Lancet_ at the time, but unfortunately the fuller
researches therein referred to have never been given to the public.
But in connection with typhoid and other zymotic fevers he has left
on the subject the indelible impression of his great genius.
* * * * *
The exertions of CHARLES MURCHISON, who died before Budd, though
much younger, were largely devoted to controverting Budd’s views
on the germ theory of zymotic diseases. He belonged to the same
Aberdeenshire family from which Sir Roderick Murchison the geologist
sprang, and was born in Jamaica in 1830. His father, himself a
physician, spent his latter days in Elgin, where his son Charles was
at first educated. As early as 1845 he entered Aberdeen University,
but in 1847-8 he commenced medical study at Edinburgh, and in
successive years gained numerous distinctions and considerable
note as a diligent and successful student. In 1850 he was Syme’s
house-surgeon. In August 1857, when he graduated, he received the
gold medal for his thesis on the Pathology of Morbid Growths. He
further studied at the Rotunda, Dublin, and in Paris, whence he went
to India, being appointed Professor of Chemistry to the Medical
College, Calcutta. In this office he was both successful as an
experimenter and as an expositor. Later, he went with the army on
the British Expedition against Burmah, and utilised the opportunity
to make valuable observations on the climate and diseases of Burmah,
which he afterwards published.
Returning to England in 1855, Murchison became a member of the
London College of Physicians, Physician to the Westminster General
Dispensary, and Demonstrator of Anatomy at St. Mary’s Hospital.
In 1856 he was appointed Assistant-Physician to King’s College
Hospital, which office he resigned in 1860, and joined the staff
of the Middlesex Hospital. He further held from 1856 the post of
Assistant-Physician to the London Fever Hospital, steadily pursuing
there as elsewhere his investigations into the nature and causes of
zymotic diseases, from which he himself twice suffered in the form of
typhus fever, which left in him heart-mischief that ultimately caused
his death.
In 1862 appeared Murchison’s work on “The Continued Fevers of Great
Britain,” dealing especially with typhus, typhoid, and relapsing
fevers. In this he treats exhaustively the history, geographical
range, causation, symptoms, treatment, and many other questions
connected with fevers, and endeavours especially to reduce his
observations to a numerical expression. His strong conviction
was that these diseases are preventable, and that they originate
in certain unhealthy and impure conditions capable of generating
specific poisons in each case. But as he commenced his work at the
London Fever Hospital believing that typhus and typhoid fever were
mere varieties of one disease, in spite of Stewart’s and Jenner’s
publications, so he maintained to the last that Budd’s view as to the
germ origin of typhoid fever was erroneous, and that even if typhoid
were communicable by germs, it could arise anew when favouring
conditions of decomposition occurred. He regarded it as proved that
typhoid fever is constantly appearing where decomposing sewage is
present, but where every effort fails to detect contamination from a
previous typhoid patient.
Murchison’s work was at once recognised as a standard one. The first
edition was rapidly sold, and it was translated into German. The
publication of a second edition was, however, delayed till 1873,
owing to Murchison’s strong desire to make his book as complete
statistically as possible. The first edition was based on 6703
cases of continued fever admitted into the London Fever Hospital
in the years 1848-57, but the second included the results of a far
larger number, 28,863, admitted during 1848-70, thus giving the
entire medical history of the fever hospital from the time that the
different continued fevers were first distinguished in 1848. Energy
and resolution of the most intense description are indicated by
such a labour. This work had to be done in the intervals of growing
practice and hospital teaching. By the time he was forty years old
Murchison was one of the leading London physicians, and continued in
full work till his death.
It was not only in regard to fevers that Murchison held a conspicuous
place and published works of great value. In 1868 he published an
excellent series of “Clinical Lectures on Diseases of the Liver,”
which reached a second edition in 1877, when he added to them
the Croonian Lectures on “Functional Derangements of the Liver,”
delivered at the College of Physicians in 1874. In 1871, when St.
Thomas’s new hospital was opened, Murchison was invited to join
its staff as full physician and joint-lecturer on medicine. In
this growing school he found full scope for his great talent as
a clinical teacher. Of his success in this capacity the _Lancet_
said[11]—“His teaching was a reflex of his singular lucidity of
thought and expression, which not only attracted the student with its
distinctness and brilliancy, but furnished him with a method on which
to found his own facts and observations.” His inaugural address as
President of the Pathological Society in 1877 gave further proof of
his marked originality of thought.
Murchison’s accomplishments and personal attractiveness were as
remarkable as his professional talents and industry. In botany,
zoology, chemistry, and geology he had very wide knowledge, and he
edited the palæontological memoirs of his friend Hugh Falconer, the
explorer of the Miocene fauna of the Siwalik Hills. Fly-fishing
was his favourite recreation. “In personal appearance,” says the
_Lancet_, “Dr. Murchison was slightly below middle stature, and
before the commencement of his fatal illness, of sturdy robust
build, with the appearance of one well fitted to bear the trials
and struggles of life. His head was large, the forehead high and
full, the hair black, and eyes of surprising brilliancy and power of
expression. In manner he was reserved, sparing of speech, and free
from that impulsiveness which hails the ordinary acquaintances of
life as esteemed friends. To those who knew him intimately, however,
his full character was revealed, and they found in him a depth
of love, tenderness, and sympathy, together with a constancy and
devotion in friendship, rarely found in more demonstrative natures.”
He attached himself particularly to the younger members of his
profession, and never spared time or trouble in assisting them with
his counsel and sympathy. He suffered severely from heart disease
for several years before his death, which took place suddenly in the
interval between the departure of one patient and the announcement of
another, on the 23d April 1879.
FOOTNOTES:
[11] Obituary notice, May 3, 1879, p. 645.