A RETROSPECTIVE
1664
GLANCE.—THE BOWEL LESION OF TYPHOID ]j’EVEH.
I with.of Aquapendente, preceptor of the immortal Harvey, shoulddescribes what he considered was an improved and easy inter- operation.° If it be a moveable tumour I cut it away with would a red-hot knife that sears as it cuts ; but if it be adherent be caused unless the nuisance that was complained of to the chest I cut it, without bleeding or pain, with a was stopped.' The unfortunate orchids were put out of wooden or horn knife soaked in aqua-fortis, with which court altogether, as, 'the case ought not to be tested by having cut the skin I dig out the rest with my fingers.'’' the effect of the smoke on delicate exotics, but by its effect It would be interesting to know with what object the He was satisfied that in this case soaking in nitric acid was performed ; did the illustrious on an ordinary garden.' the smoke was such that it would cause injury to an surgeon thus prefigure the advent of antisepticismIt is a ordinary garden, so that the plaintiff was entitled to bring pity he does not say whether he soaked his fingers as the action, the defendant must pay the costs, and if the well. A concluding observation by the reviewer seems to an amount of knowledge on the part of a occasion should arise the plaintiff could apply for an injunction. It really seems easier to obtain protection from certain class of irregular practitioners with which it is not smoke for the plants in a garden if they are only 'ordinary,' at the present day credited: 'It is little more than 50 than for the people of some parts of our large towns who years ago when Mr. Sharpe, one of the most eminent It surgeons of London, denied the possibility of the thigh. are apparently somewhat in the position of the orchids. would be interesting to know if the Vice-Chancellor would bone being dislocated at the hip-joint, an accident which look on human visitors from a tropical clime in the light of occurs daily and which the merest bone-setter in the delicate exotics, and deny them protection because they kingdom can now detect.' The final paragraph of this were not ' ordinary.' It is said that in the well-known instructive article is noteworthy: 'But it were a task equally Crumpsall case Messrs. Levinstein are appealing against difficult and unnecessary to enumerate one-tenth of ’the the decision by which they were fined at the last hearing of achievements of modern surgery (te7apus 1832) ; and it were the case. superfluous to add that it is to anatomy, and to anatomy alone, that all improvements in this department can be A RETROSPECTIVE GLANCE. traced.' After three-score and ten more years have passed THE Westnaircste Revierv of May, 1832, contains an article what will be the opinion of our successors regarding the ' on Improvements in Medicine and Surgery ' which may be achievements of modern surgery, tempus 19002 commended to the attention of the rising medical generation. 'It is a fact capable of demonstration,' says the reviewer THE BOWEL LESION OF TYPHOID FEVER. of 68 years ago, ' that since the healing art reached that IN another column we publish an interesting article by Dr. point of cultivation which entitled it to the name of science disease has been gradually decreasing both in frequency and T. J. Maclagan with the above title. The writer describes fatality. And it is equally capable of proof that the degree in graphic language the changes brought about in a Peyer’s of perfection with which anatomy has been studied at any patch during an attack of typhoid fever. Now that in every successive periods may be safely taken as the rule by which infectious disease we expect to find a micro-organism in the progress of all the other branches of the science direct causal relationship with that disease there is a may be ascertained.' Rejecting Sydenham’s dictum as tendency to consider that the pathogenic organism is the to the uselessness of searching into the bowels of dead and sole cause of the lesions characteristic of the malady. to find out the seeds of disease,' the Thus in pulmonary tuberculosis the bacillus of tubercle living creatures reviewer emphatically endorses 'Baillie’s assertion that naturally holds the most prominent place, but we ’ the dead body is that great basis on which we are to build must not forget that other micro-organisms are responthe knowledge that is to guide us in distributing life and sible for the very active pulmonary disintegration which health to our fellow creatures’' ; and then proceeds to quote frequently occurs. So Dr. Maclagan points out that in the statistics of Sir William Petty ' who died,' he informs typhoid fever elements other than the typhoid bacillus have his readers in a parenthesis, 'about 150 years since.' to be contended against. The structures in which the pathoAccording to Petty, the proportion of deaths to cures in genic micro-organism directs its specific effects are the St. Bartholomew’s and St. Thomas’s Hospitals was in his salivary and agminated glands situated in the submucous time one to seven, whereas in 1741 the corresponding coat of the small intestine, and certain changes are thereby mortality had diminished to one in 10, in 1780 to one in 14, produced which essentially consist in proliferation of their and in 1813 to one in 16. Finally, exclaims the reviewer, cellular and granular contents, with consequent swelling and 'out of 12,494 patients treated in St. Thomas’s Hospital hardening of the glands. Further, this inflammation is 259 only were buried, or one in 48.' Some remarks of His generally sufficiently severe to cause gangrene and sloughRoyal Highness the Duke of Sussex are next quoted, among ing of the affected glands. Dr. Maclagan explains them being the statement ' that comparing the value of life that the direct action of the typhoid bacillus is limited as it is now calculated to what it was 100 years ago it has to the glands of the submucous coat and that it has Duke then went on to no direct action on the mucous, muscular, or peritoneal absolutely doubled.' The Royal I expose how at one time the entire half of our population coats. But the sloughing process which destroys the were destroyed by one disease-small-pox.' Typhus fever glands necessarily also destroys the mucous membrane used to 'slay one out of every three whom it attacked,' situated over them. With the process of sloughing but at the time of writing the mortality did not amount to and suppuration there come into play other and new one in 16. Measles, scarlet fever, whooping.cough, and morbid agencies and the various forms of cocci associated no longer regarded with extreme terror. were with these processes. To these new agencies, rather than to consumption From 1799 to 1808 about 27 per cent. of those who became the typhoid bacillus, Dr. Maclagan attributes all the more ill with consumption died, but during the succeeding serious complications and all the formidable symptoms, lustrum the mortality fell to 23 per cent., and from as well as local, which are apt to show themselves 1813 to 1822 it still further decreased to 22 per cent. during the third and fourth weeks of the disease. We 'As anatomy was more attended to,' continues the believe this view of the pathology and bacteriology of reviewer, ' surgery proportionally advanced....... The typhoid fever to be a sound one, and, as already pointed out, extreme clumsiness and cruelty with which operations used it is analogous to what is found in other diseases. It would to be performed could scarcely be credited. Thus, Fabricius likewise lend support to the treatment of typhoid fever by
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ANNUAL REPORT OF IMPERIAL BACTERIOLOGIST TO INDIAN GOVERNMENT. I
1665
intestinal antiseptics which some authorities so strongly long showed that the land in question had throughout been recommend. In this connexion we may also call attention subject to taxation under the statutes and that the exempto the views expressed by Dr. Owen Paget in a letter which tion on its true construction only referred to property belonging to the hospitals in the sense of supporting their appears in this issue. __
actual buildings. With regard to the first of these points Mr. Justice in a long and learned judgment declined to make the deduction asked of him, and with regard to the second decided in accordance with what seems to us to THIS report for the year 1899-1900 has just reached us and be provided in tolerably clear terms by the section, that the The laboratory is, or is a record of very varied work. lands in question having belonged to the hospitals at the time possibly we should say was, situated at Muktesar, but in when the original Act was passed are and should always have September, 1899, most of the buildings with their valuable been exempt

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