THEHISTORICAL ACCOUNT OF EPIDEMIC TYPHUSINTRODUCTIONLouseborne typhus is one of the oldest pernicious diseases, that has been hauntingmankind. Known by the many names such as “camp fever”, “war fever”, “jailfever” and “tabarillo” and confused with many other fevers and diseases, it wasonly in the late 15th century, it was identified as a cause of majorepidemics. With Plague, Typhoid, and Dysentery, it is known to have wiped out armiesand civilian populations from the 15th to the 20th century, playing a decisiverole in the fate of wars in Europe. This paper will attempt to further analyse the historical impact of Louse-borne Typhusand how its epidemic propagation has led many to regard Pediculus humanuscorporis to have a more remarkable influence on human history than anyother parasite.EPIDEMICTYPHUS FEVER (TABARILLO, CLASSIC OR EUROPEAN TYPHUS, JAIL FEVER, WAR FEVER)Thedenomination “typhus” was derived from the Greek word typhos, meaning”smoke” resembling the delirious state,that one suffers from, during infection. Originally, “typhus”represented any of the self-limiting fevers accompanied by stupor. In 1829, theFrench clinician Louis demarcated ‘Typhus Fever’ from ‘Typhoid Fever’.
CausativeAgent and transmission : Epidemic Typhus, as isolated and identifiedby DaRocha-Lima in 1916, is caused by small Gram-negative coccobacilli-shapedbacteria, Rickettsia prowazeki, that was originally believed tobe a virus because of its minute size and difficulty of cultivation. Being anobligate intracellular parasite, it utilizes the components within the cell tosurvive and multiply. It was named in honor of H. T.
Ricketts and L. vonProwazek, who in the course of their investigations died of infection. The cellwall being excessively permeable to many large metabolites accounts for themicroorganism’s requirement for a living host. The host is believed to supplyATP, NAD, and CoA. (Brezina et al.
, 1973).Transmissionof Epidemic Typhus is through the body louse (Pediculus humanus corporis)faeces contaminated with R. prowazekii. Louse bite, causes itching andscratching , which allows the bacteria to enter the scratch or bite areathrough the skin. Indirect transmission may occur if the lice infects oneperson, who then develops the disease and the then infected lice moves to thenext individual, infecting by bites and defaecation or directly, via sharedclothing between individuals.SIGNS AND SYMPTOMS: After an incubation period of 7-14 days, fever,headache, and prostration occur suddenly.
Temperature shoots up to 40° Cin several days, with slight morning remission, for nearly 2 weeks. Headache isintense. Small, pink macules, appear on the 4th to 6th day and rapidly coverthe body, usually in the axillae and on the upper trunk excluding the palms,soles, and face. Later, the rash becomes dark and maculopapular. the rash may becomepetechial and haemorrhagic, in extreme cases. Splenomegaly occurs at times.EpidemicPropagation: Propagation is regulated in human populations by the circulationof lice between individuals. The louse is a comparatively an inefficientvector, due to short range of movement; it crawls and cannot fly.
moreover, asthe active stages survive only for 7-10 days without a suitable host to feedon, accompanied by the fact that theyare exclusively human parasites. The epidemic spread is hence favoured by theexistence of a large louse population on humans who are crowded together intheir living quarters. Scratching and itching on the part of heavily infestedindividuals causes lice to move to the outer surface of clothing and be readilytransferred to others.
Thus, in crowded tenements, jails, refugee camps, ortimes of war or disaster, when prisoners, refugees, or soldiers are unable tochange clothes or bath regularly, lice spreads quickly within the entirepopulation, especially during the winter, when bathing is made more difficultdue the chilled weather. Thus, in centuries andareas where overcrowding, malnourishment, and lack of sanitation wereprevalent, typhus spread rapidly. THEHISTORICAL IMPACT OF EPIDEMIC TYPHUS:TheFifteen Century: The first record of epidemictyphus in history, was in 1489 during the Spanish inquisition and Reconquista. Louse-bornetyphus epidemic broke out within the Spanish army killing over 17,000 soldierswithin a month out of which only 3,000 men had died in actual combat. Typhus,completely destructed the Spanish army allowing the Moors to maintain theirstronghold in Granada.
TheSeventeenth Century: The ThirtyYears War (1618-1648) was also impacted tremendously after its introduction toTyphus, during the first 15 years of thewar. Along with Plague, typhus was responsible for the death of 10,000,000soldiers, compared to merely 350,000 men who died in combat and was alsoresponsible for preventing a battle between the armies of the Swedish KingGustavos Adolphus and the Catholic army commander Baron Von Wallenstein(1632).TheNineteenth Century: The 1812campaign of Napoleon Bonaparte, against the Russians, remains the classicexample.
Napoleon’s Grand Armee, originally had over 600,000 tactful soldiers,marching their way with little resistance to take over Russian province.Despite the warnings of his medical teams, he argued that his men couldwithstand the bitterest of Russian winters- which turned out to be a fatalmistake. As the troops marched on, food and resources began todwindle, forcing soldiers to rampage the peasantry who were beset withdiseases. This resulted in Epidemic Typhus being brought into the camps alongwith the returning troops. The consequences were detrimental; more than80,000 French soldiers died within the first month of the epidemic. Weakeningthe morale of soldiers.
Only 90,000 French soldiers reached Moscow out of theoriginal army of 600,000. The majority, as high as 300,000, had diedof Epidemic Typhus and dysentery, with combat losses amounting to less than even100,000. With this drastic loss and the Russian policy of Scorched Earth Plan,Napoleon was forced to retreat. World war I:The declaration of war by Austria against Serbia in 1914 triggered by theassassination of Archduke Ferdinand quickly sparked and led to an uncontrollableglobal conflict named World War I.On theEastern Front, intense shelling of Serbian cities destroyed the existinginfrastructure , driving the populationto the streets. Minimum of 20,000 Austrians were taken prisoner by the Serbs.
There was a lack of physicians and other medical professionals, that overall,led to the rapid collapse of the health status of defenceless populations.Malnutrition, overcrowding and a lack of hygiene paved the way for typhus. InNovember 1914, typhus made its first occurance among refugees and prisoners,spreading rapidly among the troops. A year after the outbreak of hostilities,typhus killed 150,000 people, of whom 50,000 were prisoners in Serbia. Themortality rate reached an epidemic peak of approximately 60 to 70% during thisperiod. This desperate situation discouraged the Germano-Austrian commandmentfrom invading Serbia so as to prevent the spread of typhus within theirborders.
Drastic measures were taken, such as the quarantine of people with thefirst clinical signs of the disease, along with attempts to apply standards ofhygiene among the troops to prevent body lice infestations.On theRussian front, throughout the past two years of the turmoil and the Bolshevik revolution,approximately 2.5 million deaths were recorded. Typhus was latent in Russialong before the World War I. The mortality rate rose from 0.
13 per 1,000 inpeacetime to 2.33 per 1,000 in 1915. Typhus was imported and propagated throughoutthe country through the soldiers and refugees. It was during the brutal winterof 1917–18, that the biggest outbreak of typhus of modern history began in aRussia that was already devastated by famine and war. The great epidemicstarted in the big cities leading to the distant lands of the Urals, Siberiaand Central Asia. At World War I, between 1919 and 1923, there were fivemillion deaths in Russia and Eastern Europe.WORLD WAR II:Henrique da Rocha Lima, a Brazilian doctor, discovered the cause of epidemictyphus in 1916 while doing research on typhus in Germany.
nevertheless, stillover 3 million succumbed to typhus during World War I. The discovery by Cox(1938) that R. prowazeki could be grown in the yolk sac of developing chickembryos made it possible to prepare large amounts of antigen for serologicaltests. In 1940 Cox and Bell prepared an Epidemic Typhus vaccine, consisting ofa killed suspension of R. prowazeki grown on the yolk sac membrane of achick, based upon the use of tissue culture. This vaccine Even though delousingstation were set up and a typhus vaccine was developed before World War II,typhus epidemics continued to seek its victims, especially in German concentration campsduring the Holocaust, where typhus was a major scourge (Anne Frank died in acamp at age 15 from typhus) and it will never be known how many inmatessuccumbed to the disease. Upon the liberation of Buchenwald, it was discoveredthat over 8,000 inmates were suffering from typhus.
Major typhus outbreaksoccurred throughout Germany during the course of the war. with statisticsavailable in 1945 ,16,000 cases of typhus were revealed in that year. Japanalso was afflicted by the scourge of typhus during World War II, withapproximately 45,000 cases. The U.S.Army, which had been vaccinated for typhus and had good amount of supplies ofDDT available, set up many delousing stations throughout occupied areas inorder to keep the disease within Germany from spreading westward, proving to belargely successful.
The historical role played by Epidemic Typhus in World WarII, therefore, due to the mass of research on its prevention and control byCox, Durand, and others, became largely a matter of introducing and refiningmethods for its control in military and civilian populations so as to minimizeits overall effects. The threat of encountering typhus in both the European andMediterranean theaters was obviated by the compulsory immunization of allAllied personnel entering the area with the Cox vaccine.Typhus is now considered to be endemic only in specific few areas of theworld, including Eastern Africa and South and Central America. No vaccines arecurrently available to prevent typhus, but improved hygienic practices, improvedinsecticides, and antibiotics have made it easier to combat the disease and thevector that spread it. only a few epidemics (Africa, Middle East, Eastern Europe, andAsia) have occurred since then. Because of toxicity, DDT has been banned in theU.
S. since 1972.DIAGNOSIS: Thediagnosis involves identification of the bacterial genus and species by PCRtesting of a skin biopsy from skin rash or lesions,or blood samples. Immunohistological staining identifies the bacteria withininfected tissue (skin tissue, usually). Typhus can also be diagnosed, usuallylate or after the disease has been treated with antibiotics, when significanttiters of anti-rickettsial antibodies are detected by immunological techniques.
TREATMENT:Antibiotics are commonly used to treat the disease including doxycycline, themost preferred treatment. Chloramphenicol , for those not pregnant orbreastfeeding. ciprofloxacin is used for adults as a substitutefor doxycycline.CONCLUSION: After centuries of war when typhus played a leadingrole in the mortality, the disease has finally been suppressed.It is thereforeevident from this paper, that an inestimable amount of European History has beenimpacted by Man’s contact with the body louse and the pathogens it harbours.
The untold misery that has been a major part and parcel of this interaction cannever be estimated in its true sense, for historical facts and statistical dataare rather pale shadows of the impact of typhus. Indeed, the spectacularadvances of science have successfully relegated typhus to a pestilence ofyesteryear. however, the World Health Organization still describes it as a”disease under surveillance”. The eradication of poverty, famine, andwarfare are not only political, but medical concern as well. Yet one cannothelp but wonder if the truly salient feature of Man’s encounter withlouse-borne typhus is not its effects on Man’s continual struggle to overcomehis enemies, but rather the opportunity afforded to those in retrospect to feelthe humility necessary for the survival of our species in a world of which weare, of necessity, but a small part.