A Short History of Typhoid: Background information when reading Fever

A Short History of Typhoid

This article relates to Fever

Typhoid is a life-threatening illness caused by the bacteria Salmonella Typhi. Approximately 400 cases are found in the U.S. per year (mostly due to traveling) but it is prevalent in the developing world where a staggering 21.5 million people are infected per year, and 200,000 of those people die. Here is a short history of its origins, symptoms, and prevention.

History of Typhoid

Between 430-424 BC an unidentified plague killed a full one third of the population of Athens. Among those who died was the the great general, orator and statesman, Pericles, the defacto leader of Athens. It was a major moment in time as it marked the end of the Golden Age of Pericles and shifted power in Greece from Athens to Sparta. Another famous Greek, the historian Thucydides, contracted this unidentified illness but didn't die, and it is his writing about this time that elucidates the outbreak.

Scientists argue about whether this plague was, in fact, typhoid fever. A 2006 study of ancient dental pulp (the living center of the tooth made from connective tissue and cells) detected DNA sequences that are similar to typhoid, but the study has been disputed because of possible flaws in its methodology. Typhoid fever was difficult to understand and pinpoint, most likely because its symptoms are varied and systemic. In fact, until the mid-19th century doctors couldn't distinguish it from typhus and malaria. Once it was isolated and understood, Typhoid was often associated with wars. It killed over 6000 US settlers between 1607-1624, and over 80,000 Union soldiers died from it during the American Civil War.

Typhoid Symptoms

Contaminated food and water are the primary culprits of Salmonella Typhi – ingesting either of these substances allows the bacteria to enter a person's body. The bacteria then penetrate the intestines where it multiplies in lymphoid tissue. The incubation phase of typhoid fever is between 10-14 days, after which the early symptoms begin to show: headache, stomach ache, general achiness, and restlessness. Fever starts low and increases as each day progresses, reaching as high as 104 F. Accompanying these symptoms may also be cough, nosebleeds, diarrhea, or constipation. The infected person often develops a rash that lasts for a few days. If treatment hasn't been sought after a week or so, other internal problems may occur such as ulcers (because intestinal walls have become inflamed) or hemorrhaging (fragments of dead intestinal tissue erode blood vessels). And in the third week of the infection other serious complications may follow: pneumonia, heart failure, encephalitis and meningitis to name only a few. If the high fever continues, the person enters a state of delirium as well.

Without treatment, about 25% of all cases are fatal. In positive outcome situations, the fever goes down on its own, and symptoms slowly disappear. Treatment is typically a course of antibiotics, only available since the 1940s, which is highly effective (although not entirely, see below.)

The Spread of Typhoid

Contamination of public water sources is a common way for typhoid fever to spread. Also food handling by contagious people or people who are carriers (like real-life Typhoid Mary, the main character in Mary Beth Keane's Fever.) Typhoid can also be spread by flies carrying the disease or by using contaminated water for cleaning purposes. Fish from contaminated water or vegetables irrigated by contaminated water are other ways the disease can spread.

Identification of the Disease and Vaccination

In 1880, Karl Joseph Eberth, a German pathologist and bacteriologist, discovered a bacterium that he believed was the cause of typhoid, and four years later, another German pathologist, Georg Theodor August Gaffky confirmed Eberth's results.

Soon after, in 1896, Almroth Edward Wright, an Anglo-Irish-Swedish immunologist, introduced a typhoid vaccine which proved to be successful at preventing the disease, and in 1909, Frederick F. Russell, a U.S. Army physician developed another vaccine which became the centerpiece of the first vaccine program in which an entire army was immunized. This, too, was hugely successful.

Public sanitation programs and best hygiene practices were utilized around the same time – early 20th century – and these greatly contributed to the reduction of typhoid fever as well. 1908 saw the chlorination of drinking water in the US, and in 1942 antibiotics were introduced as a standard clinical treatment for typhoid. All of these advancements saw the decline of mortality due to typhoid fever. However, recent studies have shown that typhoid is becoming resistant to the three first-line drugs used in fighting it – chloramphenicol, ampicillin, and co-trimoxazole.

Bust of Pericles after Kresilas, Altes Museum, Berlin

Mary Mallon (Typhoid Mary) in a hospital bed.

Filed under Medicine, Science and Tech

This "beyond the book article" relates to Fever. It originally ran in May 2013 and has been updated for the March 2014 paperback edition. Go to magazine.