Epidemiology before Bacteriology


31


   Bretonneau also antedated (1818) the distinguished Parisian physi-
 cian, Louis, teacher of a number of prominent American physicians
 (see Chapter XI), in observing the spread of typhoid fever by con-
 tagion and in describing the characteristic lesions in Peyer's patches.
 His name for typhoid fever, dothienenteritis, was too cumbersome to
 last. Louis, who gave the name that has persisted, subsequently re-
 marked, "The contagious power of typhoid fever seems to me demon-
 strated by the facts and I accept it with no hesitation."

 Measles
              PETER LUDWIG PANUM
   In 1846 a truly unique opportunity came to a twenty-six-year-old
 Danish medical graduate, Peter Ludwig Panum,2 not yet through his
 hospital internship. An epidemic of measles raging on the Faroe Islands,
 located in the north Atlantic Ocean between the Shetland Islands and
 Iceland, caused the Danish government to send young Panum to see
 what he could do. The seventeen inhabited islands were rigidly iso-
 lated by the dangerous tides and currents and by governmental trade
 restrictions, so that no measles had been reported for sixty-five years,
 since 1781, thus creating a highly susceptible population of some 7,782
 inhabitants. The first case (April 4 or 5) occurred in a carpenter who
 had returned from Copenhagen where he had visited in a household
 with several persons ill with measles. The next cases were two of his
 intimate friends. The disease spread rapidly on the immediate island
 and more slowly to the other islands providing excellent opportunity
 to trace the transmission. Panum followed the spread in fifty-two iso-
 lated villages, obtained complete records, and determined that the incu-
 bation period was of 13-14 days and that the infection commonly
 occurred when the primary case was in the eruptive stage. A lasting
 immunity was demonstrated in that all of the ninety-eight older persons
 who had had the disease in 1781 escaped the disease in 1846.
 If among 6,ooo cases of which I myself observed and treated about i,ooo,
not one was
 found in which it would be justifiable, on any grounds whatever, to suppose
a miasmatic
 origin of measles, because it was absolutely clear that the disease was
transmitted from
man to man and from village to village by contagion, whether the latter was
received by
immediate contact with a patient, or was conveyed to the infected person
by clothes, or
the like, it is certainly reasonable at least to entertain a considerable
degree of doubt
as the miasmatic nature of the disease .... It is beyond doubt that the surest
means
of hindering the spread of the disease, is to maintain quarantine.