Cracking Typhoid Fever

Photomicrograph of salmonella typhi, Centers for Disease Control and Prevention (CDC) (Image Numer: 2115, from https://www.britannica.com/science/typhoid-fever

Today we are in the midst of a scary virus that brings with it a mind-boggling number of unknowns. We know the virus can be dangerous, but some people can have mild symptoms. We know it can invade the lungs, cause pneumonia, and may be so bad that patients die, even when on ventilators. And yet, it might not only attack the lungs., Lately, we have been hearing stories about younger people with COVID-19 developing blood clots and dying from strokes.
 
We do not know how to make people well yet, although scientists are working on it. We do not have a vaccine to prevent people from catching the virus, that may be a year or more in the future. We do not even have a clear idea of who has the virus, who hasn’t, and who has had it because there are not enough testing kits in the USA.
 
Feeling anxious? Welcome to the 19th century, friends.
 
As I mentioned in earlier posts, people like Maggie and Eli living in the mid-19th century were victims to numerous diseases and epidemics with the potential to debilitate and destroy a person’s life. According to an article called “Common Diseases of the 19th Century” at a student research site at Old Dominion University (VA):
 
People were dying of diseases, such as cholera, typhus, smallpox and tuberculosis. “It was estimated that as many as 1 person in 10 died of smallpox. More than half the working class died before their fifth birthday”. From the average laborer to the wealthiest man, these diseases had a negative impact on all of those residing in America. The main goal at the time was to prevent and control these diseases to limit more deaths, but the increasing population in urban areas made that more and more difficult. As people moved into these urban areas, they also brought a plethora of diseases. There needed to be a solution. To accomplish this, the society pursued the process of sanitation. This involved ensuring that Americans lived in an environment of clean air, water, etc. Because of the rapid and increasing amount of deaths, citizens took on the overall responsibility of public health to avoid the harsh symptoms of the diseases. (Antrene’ Nicole, et al, Common Diseases of the 19th Century).
 
Does that sound familiar? What we’re doing today is similar in that once again the public has been asked to help prevent the spread of COVID-19. Those “asks” are 1. stay at least 6 feet away from other people (social distancing), 2. limit contact with other people (stay at home), 3. wear a mask to prevent unknowingly spreading the disease to other people (mask up), and 4. practice good hygiene (wash your hands).
 
In Maggie’s day, fighting disease was limited by medical and scientific knowledge. The concept of microorganisms was just emerging, and germ theory was embryonic. Hygiene was practically unheard of. Generally speaking, people did not bath daily, and I admit, my characters are probably cleaner than people were. Babies usually were left in wet diapers and only changed when the child had a bowel movement. Again, I just couldn’t go there and learned that some studies done at the time recommended changing baby frequently. So Lydia tell Maggie to change baby Faith when she wets her diapers, having noticed that the discipline reduced the incidence of “diaper rash.”
 
For the most part, though, diseases and fevers were unleashed regularly upon families and populations. No one really know what caused them and how to recover from them.
 
That is why prevention becomes such a huge deal if you don’t have a cure or a vaccine. Today some people might argue that hand washing as a preventative measure for COVID-19 is merely a distraction, something to give us ‘something to do” so we think we’re helping. And maybe it is. But I can tell you one thing: hand washing for one particular 19th-century scourge was a life saver. That disease is typhoid fever.
 
If you have read my earlier posts, typhoid fever was not understood in the mid-1860s and was particularly virulent in Civil War military encampments, where sanitation was lax if not absent. Sadly, the bacillus responsible for the disease was not discovered until 1880. However, a few physicians earlier had suspected that the cause was a microorganism. And in 1873 Dr. William Budd (Bristol, England) “demonstrated…that typhoid fever could be transmitted by a specific toxin present in excrement and that the contamination of water by the feces of patients was responsible for that propagation” (Filio Marineli, et al, 132).
 
The disease’s code finally was broken in the late 1870s-early 1880s:
 
It was Karl Joseph Eberth, doctor and student of Rudolf Virchow, who in 1879 discovered the bacillus in the abdominal lymph nodes and the spleen. He had published his observations in 1880 and 1881. His discovery was then verified and confirmed by German and English bacteriologists, including Robert Koch. The genus “salmonella typhii” was named after Daniel Elmer Salmon, an American veterinary pathologist, who was the administrator of the USDA research program, and thus the organism was named after him, despite the fact that a variety of scientists had contributed to the quest. (Filio Marineli, et al, 132).
 
The discovery also confirmed William Budd’s theory that every case could be related to an earlier case (Filio Marineli, et al, 132). You might be asking, “So what?” Well, this was a game-changer with regard to limiting spread. If the bacillus for typhoid fever remained in the spleen and abdominal lymph nodes of a recovered patient, then that person possibly could spread the disease to uninfected people. If you could discover who the asymptomatic carriers are, then you could reduce the spread.
 
Again, does this sound kind of familiar? It should.
 
And so, Monday (or Tuesday’s) blog will cover the story of a woman by the name of Mary Mallon and how, through contact tracing, physicians discovered that she was an asymptomatic typhoid fever carrier.
 
 
 
Take care, friends, and stay well.
 
 
Janet R. Stafford
 
 
Research
 
Antrene’ Nicole, Divine Desiree, Travonna Raylena, Aja Nicole, “Common Diseases of the 19th Century,” 19th Century Medicine, Old Dominion University.
https://sites.wp.odu.edu/19thcenturymedicine/sub-topic-1/
 
Filio Marineli, Gregory Tsoucalas, Marianna Karamanou, George Androutsos, “Mary Mallon (1869-1938) and the history of typhoid fever,” History in Gastroenterology, Annals of Gastroenterology, (2013) 26, 132-134
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959940/