A Florentine physician, described the pestilential disease in his

A Historical Account of Epidemic Typhus

The
four postulates of the Germ Theory of Disease, which states that diseases are
caused by microorganisms, that had been laid down by Robert Koch in the late 19th
century were a remarkable advancement in the field of Microbiology, and
provided an understanding of the cause, and possible cure of various diseases.

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Known
by various synonyms such as camp fever, jail fever, famine fever, putrid fever,
louse-borne typhus, etc., the infamous bacterial disease typhus has been
responsible for various epidemics in history. As the names suggest, these
epidemics tend to follow conditions when social organisation is disrupted, and
public health and personal hygiene is compromised. Epidemic typhus is caused by
the bacterium Rickettsia prowazekii, and transmitted by Pediculus
humanus humanus, the body louse, as discovered by Charles Nicolle in 1909.

Manifestations:

Epidemic
typhus is a life-threatening, acute exanthematic feverish disease. Once in the
victim’s blood stream Rickettsia prowazeki begins to multiply.
About twelve days after infection, the clinical symptoms of the disease begin.
It is primarily characterised by the abrupt onset of fever with painful
myalgia, a severe headache, malaise and a rash. Non-specific symptoms sometimes
include a cough, abdominal pain, nausea and diarrhoea. The rash, which is a
characteristic of typhus fever, appears on the abdomen a few days after the
onset of the symptoms, and radiates centrifugally to the extremities. Gangrene
and necrosis of the extremities, leading to the need for amputation, might also
be observed. The term typhus comes
from the Greek word “tuphos”, meaning “smoke” or “stupor”, evoking the
delirious state that infected individuals may develop. Neurologic symptoms
include confusion and drowsiness. Coma, seizures and focal neurologic signs may
develop in a minority of patients.

History:

The
first written recordings of typhus came in 1489 during the Spanish army’s siege
of Granada. An epidemic of louse-borne typhus had struck the Spanish army, and
within a month had killed 17,000 of the original 25,000 soldiers. Of the total
war causalities, only 3,000 Spaniards had died in actual combat. The remnants
of the Spanish army fled, and in so doing, introduced typhus to many other
parts of Europe.

In
1546, Girolamo Fracastoro, a Florentine physician, described the
pestilential disease in his famous treatise on viruses and contagion, De
Contagione et Contagiosis Morbis.

In
1759 authorities estimated nearly 25% of English prisoners lost their lives to
this disease, thus earning the name gaol or jail fever.

It
had also afflicted the soldiers of Napoleon’s Grand Army in Vilnius in 1812,
after their retirement from Russia. It is estimated that fewer than 100,000
French soldiers lost their lives to Russian soldiers, while as many as 300,000
French soldiers perished from typhus.

Nicolle’s
findings in 1909 put an end to the mystery behind the occurrence of the
disease. However, research and control techniques did not advance rapidly
enough to prevent major outbreaks of typhus on the Eastern Front during the
First World War. Austria’s declaration of war on Serbia (Yugoslavia) following the
Archduke Ferdinand’s assassination was immediately followed by an all-out
invasion of Serbian soil by Austrian forces. Over-crowding, a dearth of
sanitary facilities and hospitals, and the general panic caused by the Austrian
invasion prepped the stage for the proliferation of infected body lice.

In November 1914, typhus made its first appearance among refugees and
prisoners, and it then spread rapidly among the troops, leaving the entire country helpless
amidst one of the worst epidemics in history. It killed 200,000 Serbian
soldiers on the front, almost one-quarter of their entire armed forces, and
almost 30,000 of the 60,000 Austrian prisoners captured in the counterattack. The
mortality rate reached an epidemic peak of approximately 60 to 70%. This
dramatic situation dissuaded the German-Austrian commandment from invading
Serbia in an attempt to prevent the spread of typhus within their borders.

Drastic
measures were taken, such as the quarantine of people with the first clinical
signs of the disease, but attempts were also made to apply standards of hygiene
among the troops to prevent body lice infestations. On the Western Front,
although body lice were also endemic among the troops, there was no outbreak of
typhus. The situation lacked the R. prowazekii bacteraemia to trigger a
typhus epidemic, as had happened on the Eastern Front.

On
the Russian front, throughout the last two years of the conflict and during the
Bolshevik revolution, approximately 2.5 million deaths were recorded. Soldiers and refugees imported
typhus and propagated it across the country. It was during the hard winter of
1917– 1918 that the biggest outbreak of typhus in modern history began in a
Russia that was already devastated by famine and war.

As
World War II raged, typhus reappeared in war-torn areas and in Jewish ghettos,
where cramped, harsh conditions were a perfect breeding ground for lice. The
Nazis employed Dr. Rudolf Weigl to produce a typhus vaccine. Weigl created a
technique that involved raising millions of infected lice in a laboratory and
harvesting their guts to get the materials for a vaccine.

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