William Budd and typhoid fever

Abstract

William Budd (Figure 1) was an English country doctor whose observations on typhoid fever had far-reaching consequences. He was born in 1811 into a strongly medical family. His father was a doctor in North Tawton, Devon, and also a naval surgeon in the war with France in 1794; seven of the ten sons studied medicine. William was initially apprenticed to his father, and then spent four years in Paris, where he came under the influence of Pierre Louis, the anatomical pathologist and clinical investigator (and father of evidence-based medicine1). Louis took a special interest in the gastroenteritic illness known as putrid fever, and noted that the Peyer's patches of the small intestine showed inflammation and ulceration, coupled with enlargement of the mesenteric lymph nodes2. Budd was also impressed by the work of Bretonneau, a French country doctor who reported an outbreak of similar disease in a military school in Tours3. The students who perished in this outbreak likewise proved to have ulcerated Peyer's patches; moreover, the surviving students who were sent home communicated the disease to some of their attendants. It was his experiences in France that sparked Budd's interest in how the disease was spread4. In England the condition was commonly known as typhoid fever because of certain resemblances to typhus, although the two conditions were sometimes confused. The disease was characterized by sudden onset of fever, headache and nausea, commonly accompanied by diarrhoea or constipation. The causal bacterium, Salmonella typhi, was ultimately identified in 1880. Figure 1 Portrait of William Budd (J B Black, London, 1867). Reproduced by permission of the Royal Society of Medicine