Typhus

“ At least we can say for certain that the plague of Athens showed more of the symptoms of typhus fever than of any other known disease; and if Dr. Crawfurd is wrong he had made a very shrewd guess. From my own experience of typhus, which is small, I should certainly be inclined to support him. But typhus nowadays is a thing almost of the past except in times of war. That we owe simply to washing ourselves and our clothes better than of old. ”

“ We now know through the researches of Ricketts and others that typhus is carried by vermin, the body louse, Pediculus vestimenti, acting as the vector. Thus the etiology of typhus has suddenly been made clear and we are in a position to formulate measures for prophylaxis and quarantine which will prevent the development of the disease in epidemic form. There is much yet to be learned; perhaps other insects also may act as carriers, but there can be no doubt that typhus is almost exclusively insect-borne. ”

“ The infection is communicated from man to man, and very often it is contracted from the clothes, linen, and other effects of typhus patients. Recovery from the disease usually renders a person immune against a second attack. Typhus fever frequently appears nowadays in the eastern and south-eastern parts of Europe, in Hungary and Galicia, and also in Spain, Italy, and Ireland. ”

“ If a score, or a dozen or half-a-dozen deaths in a week are set down to spotted fever, it probably means that a large part of the remaining hundred, or seventy, or fifty cases of “fever” not called spotted were really of the same kind, namely typhus. In the plague itself, the “tokens,” which were of the same haemorrhagic nature as the larger or more defined spots of typhus, were exceedingly variable [19] . One of the synonyms of typhus (the common name in Germany) is spotted typhus ”

“ In the same manner as pathologists disagree as to the question, whether the typhus and typhoid fever in man are one and the same disease, so should we long debate, without coming to an agreement, as to that which relates to the typhus and typhoid fever of the ox. ”

“ Even before the full demonstration of the germ theory, they had grasped the conception that the battle had to be fought against a living contagion which found in poverty, filth and wretched homes the conditions for its existence. One terrible disease was practically wiped out in twenty-five years of hard work. It is difficult to realize that within the memory of men now living, typhus fever was one of the great scourges of our large cities, and broke out in terrible epidemics—the most fatal of all to the medical profession. ”

“ This description of fever is usually termed typhus or nerve fever. It characterizes all forms of typhoid disease of which the following features constitute the prominent symptoms.
To a peculiar degree, chiefly young and strong individuals of from 15 to 30 years of age are attacked by this disease, while those in early youth and of more advanced years are much less subject to the same.
It is a complaint very dangerous to those who eat and drink to excess and without discretion. Strong excitement of the mind, such as a shock or great anguish, will undoubtedly favor the appearance of typhus. ”

“ It may be transmitted through the air for short distances, not nearly so far as the air will carry the contagion of smallpox. In well-ventilated rooms there is less danger of infection, and a typhus patient should have at least 1,500 cubic feet of air space. The contagion may be transmitted in all stages of the disease and during convalescence.
Physical weakness, anxiety and worry, improper food, and poverty, are disposing conditions for infection by typhus. The mortality is about 10 per centum—much less than that of smallpox. ”

“ But until the past year we knew neither the parasitic germ which causes typhus fever nor the mode by which it passes from one individual to another. A vague idea that it was spread through the air prevailed. Typhus is remarkable for the frequency with which [Pg 232] the nurses and doctors attending a case become infected. About 20 per cent. of those attacked by it die, but in persons above forty-five years of age the mortality is much greater—about half succumb.
Dr. Nicole and his colleagues of the Institut Pasteur in Tunis have recently had the opportunity of studying typhus there. ”

“ Very dangerous for the dissemination of the disease was the belief that the placing of typhus fever patients together with other invalids did no harm, but rather that the congregating of numerous typhus fever patients by themselves caused the contagion to develop with especial severity. The Saxon staff surgeon Neumann, for example, writes in regard to this question: [112] ‘Anybody who lies in a bed to which the poison is still clinging will without fail contract the disease ”

“ The after-effects of neglected typhus are often worse than the original disease; and amongst ignorant peasants, without doctors, every case of typhus is a neglected case. One day a man brought his little girl (Rositza by name) in an ox-wagon from a distance of thirty miles. The child was suffering from a loathsome-looking leg, the result of neglect after typhus. The two bones of the leg were as bare of flesh as though a dog had gnawed them clean; and the foot was a gangrenous mass of black pulp. ”

“ The guinea pig is susceptible to the virus as well as the monkey but only shows temperature rise. Nicolle has shown that lice do not become infective until about the tenth day after feeding on typhus blood. The virus is found in the blood of man and in the spleen and blood of monkeys and guinea pigs.
Plotz has isolated a Gram-positive pleomorphic bacillus from the blood of typhus patients which has been named B. typhi exanthematici. This organism is of historical interest only and apparently has nothing to do with the causation of typhus fever. ”

“ There is reason to think that the fever, if slow and weakening, was seldom fatal, that it was typhus mitior, and that it was sometimes, perhaps often, relapsing. One glimpse we get of it in the family of the afterwards celebrated Dr Edward Jenner of Berkeley, in the winter of 1794-95. He thus writes to a friend about the visitation of “grim-visaged typhus:”
“You shall hear the history of our calamities. ”

“ Typhus fever, the scourge of modern Europe, may not originate in any condition of the soil produced by man, but it sweeps thousands in the prime of life from the earth when placed in circumstances clearly dependent on man himself. Ten thousand young men are lodged in a barrack; speedily hundreds of these are swept off by typhus or consumption of the lungs; now something causes this, and the cause may rest with man himself. Pestilence and typhus follow in the train of famine ”

“ The principal diseases in the hospitals were the typhus gravior and mitior of Doctor Cullen. Men who came into the hospitals with pleurisies or rheumatisms, soon lost the types of their original diseases, and suffered, or died, by the above-mentioned states of fever.
9. The typhus mitior always prevailed most, and with the worst symptoms in winter. A free air, which could only be obtained in summer, always prevented, or mitigated it. ”

“ In approaching a sick bed of this kind, a person not much accustomed to such visits will be very liable to receive the infection; and the unpleasant smell will be much sooner perceived than by the physician or other attendants. We conclude that a malignant typhus is more apt to generate contagion, because slight cases are found not to extend to others, even though no mode of precaution has been used. The disease itself is incapable of generating infection, till after a certain period ”

“ He published in 1839 ‘A Short Treatise on Typhus Fever,’ based on observations made in the wards of St. Bartholomew's Hospital, but containing more extracts from other writers than notes of what he had seen in his own practice. The most interesting observation is in relation to the infection of typhus being conveyed by a corpse. He mentions that 136 students of anatomy at St. Bartholomew's minutely dissected seventeen bodies, in which the cause of death was typhus, while only two took the disease, and these were also exposed to contact with living patients. ”

“ Surely if the disease had been typhus fever, or any other capable of contaminating the atmosphere of a sick apartment, or giving out infection more directly from the body of a patient, the result must have been different ”

“ In the event of perforation of the intestines and severe internal hemorrhage supervening, the chances of saving life are slender.
D. Treatment.
The treatment of typhus requires, in the first place, a correct judgment of the physical condition of the patient in determining the fever treatment to be applied. Success in severe cases of typhus will only be secured by those who understand the correct methods of treating the skin. Robust patients, with reserve energy and resisting power, may receive the unrelaxing application of repeated whole packs or cool full baths. ”

“ They found that the ordinary local monkey could not be made to take the disease. But a drop of blood of a typhus patient injected into a chimpanzee (which is far nearer akin to man) produced the disease after an incubation period of three weeks. This fact was definitely established. From what is now known as to relapsing fever, malaria, yellow fever, plague, and sleeping-sickness, it seemed probable that some migratory insect must be the carrier of the typhus infection from man to man. ”

“ Not only would I have ordered or carried out this autopsy, but the camp administration would have ordered it. People might think that these persons perhaps died of typhus. I must say that after a two-day incubation period—that was the period between inoculation and death—no one ever died of typhus. The shortest time for typhus deaths, that is the incubation period plus length of disease, is ten days to fourteen days. And these early deaths are supposed to be cases with a high pathogenic virus originating directly from human beings. ”

“ We may likewise infer, and a watchful appreciation of the facts contained in the veterinary medical journals would show that this opinion is not unfounded, that the special disease which constitutes this typhus (similar in that respect to epidemic diseases) , may develop itself in one beast by accident, spontaneously, sporadically—that is to say, without immediate contagion; in a word, apart from those epizootic conditions which alone render its propagation possible. ”

“ Thus the infection of the small-pox is the same all over the world. The variolous matter will never produce the measles in any country, nor will the typhus produce a pleurisy. The plague manifests itself to be the same distemper in all its various degrees of malignity, though even this dreadful disease is sometimes so mild that it does not confine the patient to his bed. There must therefore be some certain constitution in the nature of the cause which produces such and such diseases, as certainly as in the seed of particular vegetables, which gives to each its proper appearance and shape. ”

“ While typhus fever is a disease of overcrowding and poverty, typhoid may occur where such conditions are entirely excluded; and the connexion of this malady with specific emanations given off from decomposing organic or fæculent matters, or with contamination of food or water by the products of the disease, is now almost universally admitted. Alike in sporadic cases and in extensive epidemic outbreaks the existence of insanitary conditions in house drainage, water supply, &c., can in the majority of instances be made out. ”

“ The same phenomena are sometimes observed in the typhoid fever of man, which offers moreover some analogy with the contagious typhus of the ox; but as the ox and the horse have likewise the real typhus fever, they may some day supply us with the preventive virus for that fever, in the same manner as the cow now supplies us with the preventive virus for the small-pox. ”

“ Actual inflammation of the meninges has only been detected in a very few cases. There may also be congestion of the spinal membranes, increase of the spinal fluid, and softening of the cord itself. The ganglia of the sympathetic system appear to undergo a form of granular degeneration.
DIAGNOSIS.—The diseases which most closely resemble typhus fever are typhoid fever, measles, meningitis, and typhoid pneumonia.
The circumstances under which typhoid and typhus fever occur are different. Typhoid is never generated by overcrowding, and if contagious at all is much less so than typhus. ”

“ Now that we have examined the measures which prudence directs us to take to defend ourselves against the causes which produce and propagate typhus, let us think of the means of preventing it, when the contagion threatens to diffuse itself over a whole kingdom, as at present it is doing in England. ”

“ The disease always began with a chill, and was characterized now by obstinate constipation, now by diarrhoea; no patient who survived the thirteenth day died. And even if an exanthema was not 144observed, there can be no doubt that it was typhus fever which raged in Kiel. Weber himself calls the disease contagious typhus.
4. The Appearance of Typhus Fever in South Germany Typhus fever was conveyed to various places throughout South Germany by the few soldiers that returned from Russia. ”

“ The following tables show for England and Wales and for London a steady decline of the deaths from typhus and simple continued fever since the end of the epidemic period 1869-71, which was the last epidemic of typhus and relapsing fever in this country hitherto. The deaths from enteric fever, it will be seen, remained somewhat steady (in a growing population) for about ten years after the separation, and then began to decline. ”