Relapsing typhilitis to CFHR5 nephropathy: the thrill of discovery

I expect you have never heard of CFHR5 nephropathy? Neither had I until I helped judge a grand rounds contest. It isn't the kind of case you would expect to find in a multispecialty journal like JRSM, but what fascinates me about it is the thrill of discovery, a mystery unravelled. Daniel Gale, the prize winner of the RSM Grand Rounds Competition 2010 describes a clinical quest whose solution was hidden in gene analysis and the Troodos Mountains of Cyprus (JRSM 2011;104:186–90).

Gale's account resonates with a past age of medicine when new clinical findings were first presented at this society and in this journal. The scientific world has moved on, with blockbuster discoveries – if any such are possible – being trumpeted at international specialty congresses and in the pages of the highest impact factor journals. Education instead of revelation has become the central purpose of the majority of medical societies and medical journals.

But rediscovering the past remains a valuable learning experience, and is the rationale for a series of extracts from Doctoring History, an RSM Press publication on the most ‘famous, popular and influential’ articles from this journal's archive published between 1809 and 1907. The series continues with Frederick Treve's first surgical operation for appendicitis or ‘relapsing typhilitis’ as he preferred to describe it (JRSM 2011;104:191–7). Indeed, William Osler considered ‘appendicitis’ to be medical jargon and dissuaded James Murray from including it in the New English Dictionary.

Treves did not remove the appendix in his operation, say Manoj Ramachandran and Jeffrey Aronson, the authors of the new book, he merely straightened out a kink and closed the abdomen. But Treves had to fend off the claims of an American surgeon, Thomas George Morton, whose first appendix operation was performed in 1888. Treves was able to counter that he had operated in February 1887 and brought the matter before the Royal Medical and Surgical Society in September 1887. Treves was first, the American second. The journal article confirms the date Treves report on ‘Relapsing typhilitis treated by operation’ was received and the date it was read at the Society. His patient, incidentally, made a ‘perfect recovery’.

Scientific disputes live on, and so does the possibility of discovering a new disease or inventing a novel operation, as Gale has demonstrated. We can now move from clinical presentation to gene analysis in a matter of moments. But we have paid a heavy price. Invention of medical jargon far outstrips medical discovery. Osler and Treves would despair at our folly.