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British and Foreign Medico-Chirurgical Review, Vol. 25 (Classic Reprint)




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Stand:2015-08-04 03:50:33

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Excerpt from British and Foreign Medico-Chirurgical Review, Vol. 25 There are a few names in the history of medicine which are inseparably connected with the diseases which their possessors have been the first to discover or to distinguish. It is in this way that the name of the eminent physician who has within the last year passed from among us is most widely known and will be longest remembered; and it is thus that for years past we have remembered the names of Hope, Rayer, Laennec, Corvisart, and many others who have been the first to break ground each on his own special field of pathology. Like honour is due to M. Bretonneau, of Tours, for his admirable investigation of the epidemic disease to which he has attached the name Diphtheritis. Profoundly impressed with the truth of the aphorism of Laennec, that diseases can only be certainly distinguished by their anatomical characters, M. Bretonneau based his inquiry exclusively on post-mortem investigations, and prosecuted this line of research so far as to arrive at the conclusion with respect to several important diseases previously supposed to have no relation to one another, that they are connected either by identity in their accompanying anatomical appearances, or by so complete a similarity that they may be considered as phases of the same morbid process. An epidemic of malignant sore-throat which occurred at Tours in the year 1818, was the occasion of his earliest observations. His first memoir is mainly devoted to the consideration of the affections which had previously been described in France as epidemic croup, or malignant angina. The second contains in one section a careful description of the epidemic above mentioned, which is followed by a historical summary of previous outbreaks; while two others are devoted to the communicability of the disease by contagion, and to its treatment. In 1825 and 1826 the epidemic again broke out in the neighbourhood of Tours, at La Ferriere and Chenusson, and formed the subject of new researches. These four papers, with various appendices, constitute the treatise on Diphtherite, the first edition of which appeared in 1826. The word Diphtheritis, first employed by Bretonneau in this form, and years afterwards modified to its present form. Diphtheria, in deference, as it would appear, to the objections of critics, involves in itself the kernel of his doctrine, the dominant idea of his whole writings, - the specificity (to adopt a French word) of the pellicular exudation. Diphtheria, according to Bretonneau, is a diseased condition sui generis which may have its seat in the mouth, the fauces, the larynx, or on the blistered surface of the skin; and in all of these situations has the same specific characters. Its specificity consists anatomically in the formation of a pellicle of definite structure pathologically or dynamically in the fact that this pellicle has the power of reproducing itself. Nothing is diphtheria that has not a pellicular exudation; no such exudation is diphtherical which is not capable of acting as a virus or contagium. The pellicular exudation is anatomically identical in all situations, but the disease is to be distinguished not merely by its anatomical characters, but by the additional fact that the exudation is the result or effect of the application of a specific virus to the affected surface, and is in itself capable of similarly affecting other surfaces. We have thus as succinctly as possible stated our authors doctrine; we will now place before the reader some passages in which it is laid down more at length in his own words. It is a serious inconvenience attending the arrangement of the Treatise, that as each separate memoir is complete in itself, almost every question is discussed three or four times, and it is therefore necessary to refer to as many passages in order to arrive with certainty at the authors meaning.


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