THE since ages. Known by the many names

THE
HISTORICAL ACCOUNT OF EPIDEMIC TYPHUS

INTRODUCTION

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Louse
borne typhus is one of the oldest pernicious diseases ,that has been haunting
mankind since ages. Known by the many names such as “camp fever”, “war fever”,
“jail fever” and “tabarillo” and confused with many other fevers and diseases,
it was only in the late 15th century, it was identified as a cause
of major epidemics. With Plague, Typhoid, and Dysentery, it is known to have wiped
out armies and civilian populations from the 15th to the 20th century, playing
a decisive role in the fate of wars in Europe. This paper will attempt to
further analyse the historical impact of Louse-borne Typhus and how its
epidemic propagation has led many to regard Pediculus humanus corporis to
have a more remarkable influence on human history than any other parasite.

EPIDEMIC
TYPHUS FEVER (TABARILLO, CLASSIC OR EUROPEAN TYPHUS, JAIL FEVER, WAR FEVER)

The
denomination “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, the French clinician Louis demarcated ‘Typhus Fever’ from
‘Typhoid Fever’.

Causative
Agent and transmission: Epidemic Typhus, as isolated and
identified by DaRocha-Lima in 1916, is caused by small Gram-negative
coccobacilli-shaped bacteria, Rickettsia prowazekii, that was
originally believed to be a virus because of its minute size and difficulty of
cultivation. Being an obligate intracellular parasite, it utilizes the
components within the cell to survive and multiply. It was named in honour of
H. T. Ricketts and L. von Prowazek, who in the course of their investigations
died of infection. The cell wall being excessively permeable to many large
metabolites accounts for the microorganism’s requirement for a living host. The
host is believed to supply ATP, NAD, and CoA. (Brezina et al., 1973).

Transmission
of Epidemic Typhus is through the body louse (Pediculus humanus corporis)
faeces contaminated with R. prowazekii. Louse bite, causes itching and
scratching, which allows the bacteria to enter the scratch or bite area through
the skin. Indirect transmission may occur if the lice infects one person, who
then develops the disease and the then infected lice moves to the next
individual, infecting by bites and defaecation or directly, via shared clothing
between individuals.

SIGNS AND SYMPTOMS: After an incubation period of 7-14 days, fever, headache, and prostration
occur suddenly. Temperature shoots up to 40° C in several days, with
slight morning remission, for nearly 2 weeks. Headache is intense. Small, pink
macules, appear on the 4th to 6th day and rapidly cover the 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 become petechial and haemorrhagic,
in extreme cases. Splenomegaly occurs at times.

Epidemic
Propagation: Propagation is regulated in human populations
by the circulation of lice between individuals. The louse is a comparatively an
inefficient vector, due to short range of movement; it crawls and cannot fly. Moreover,
the active stages survive only for 7-10 days without a suitable host to feed
on, accompanied by the fact that they are exclusively human parasites. The
epidemic spread is hence favoured by the existence of a large louse population
on humans who are crowded together in their living quarters. Scratching and
itching on the part of heavily infested individuals causes lice to move to the
outer surface of clothing and be readily transferred to others. Thus, in
crowded tenements, jails, refugee camps, or times of war or disaster, when
prisoners, refugees, or soldiers are unable to change clothes or bath
regularly, lice spreads quickly within the entire population, especially during
the winter, when bathing is made more difficult due the chilled weather. Thus, in centuries and areas where overcrowding,
malnourishment, and lack of sanitation were prevalent, typhus spread rapidly.

THE
HISTORICAL IMPACT OF EPIDEMIC TYPHUS:

The
Fifteen Century: The first
record of epidemic typhus in history, was in 1489 during the Spanish
inquisition and Reconquista. Louse-borne typhus epidemic broke out within the
Spanish army killing over 17,000 soldiers within a month out of which only
3,000 men had died in actual combat. Typhus, completely destructed the Spanish
army.

The
Seventeenth Century: in the
Thirty Years War (1618-1648), the first 15 years, was also impacted tremendously
after its introduction to Typhus. Along with Plague, typhus was responsible for
the death of 10,000,000 soldiers, compared to merely 350,000 men who died in
combat. (1632).

The
Nineteenth Century: The 1812 campaign of Napoleon Bonaparte, against the
Russians, remains the classic example. Napoleon’s Grand Armee, originally had
over 600,000 tactful soldiers, marching their way with little resistance to
take over Russian province. France and
Russia had been tense allies. In 1812, His army entered Russian
controlled Poland.

Poland is where things took a turn for Napoleon. The
territory was filthy beyond belief. The peasants were unwashed, with matted
hair and infested with lice and fleas, and the wells were fouled. Being
in an enemy state, the resources soon began to dwindle and it became difficult
to provide food and water to the soldiers. The army was too huge to keep its
military formation intact, and the greater part of the army dissolved into
straggling and sprawling mobs. Many of the soldiers, therefore raided the
homes, livestock, and fields of the local peasants that were full of parasite.
The typical battlefield diseases of dysentery and other intestinal diseases
began to appear, and though new hospitals were set up, they were unable to deal
with the large numbers of sick soldiers.

Several days after crossing the Nieman, many soldiers
began to develop high fever and red rash on their bodies. Some of them
developed a bluish tinge to their faces and died. Typhus had made
its appearance.

Typhus, had been present in Poland and Russia for many
years, but it had worsened since the Russian army had devastated Poland while
retreating from Napoleon’s forces. A lack of sanitation combined with the
unusually hot summer made an ideal environment for the infestation of lice. It
was an entire century after the 1812 campaign, before scientists discovered
that typhus is found in the faeces of lice.

The French soldiers were dirty, sweaty and lived in the
same clothes for days; providing the perfect environment for lice to feed and
find a home in his clothing. Once the clothes and skin of the soldier was
contaminated with lice excreta, the smallest scratch or abrasion was enough for
the germ to enter the soldier’s body. To magnify the problem, the soldiers were
sleeping in large groups in confined spaces, for safety. This closeness enabled
the lice to get transmitted easily. Only a month into the campaign, Napoleon
lost 80,000 soldiers who were either incapacitated or had died from typhus.

 

 

Soldiers
suffering from typhus, lying in the streets.

 

On July 28, Napoleon’s officers expressed concerns with
him that the war with the Russians was becoming fatal. The loss of troops to
disease and desertion was inestimable. In addition to which, the problem of
finding provisions in hostile territory was becoming daunting, he argued that his men could withstand the
bitterest of Russian winters- which turned out to be his biggest mistake.

Napoleon and his sick, weary soldiers marched on. The
Russians retreated as the French advanced, drawing Napoleon deeper into Russian
territory. By Aug. 25, Napoleon had lost 105,000 of his main army of 265,000,
leaving only 160,000 soldiers. Within two weeks, typhus had reduced the army to
103,000.

On Sept. 7, French forces engaged the Russians resulting
in heavy casualties. Napoleon then marched onto Moscow with only 90,000
soldiers. He had expected the Russians to surrender; however, the citizens
simply left Moscow to Napoleon after burning three-fourth of it leaving no food
or provisions. Fifteen thousand reinforcements joined Napoleon in Moscow, but
of those, 10,000 died of typhus. With the Russian winter rapidly approaching,
Napoleon had no choice but to retreat.

World
war I: During World War I, minimum of
20,000 Austrians were taken prisoner by the Serbs. There was a lack of
physicians and other medical professionals, that led to the rapid collapse of
the health status of defenceless populations. Malnutrition, overcrowding and a
lack of hygiene paved the way for typhus. In November 1914, typhus made its first
occurrance 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. The mortality rate reached an epidemic peak of
approximately 60 to 70% during this period. Drastic measures were taken, such
as the quarantine of people with the first clinical signs of the disease, along
with attempts to apply standards of hygiene among the troops to prevent body
lice infestations.

In Russia, over past two years of the turmoil
and the Bolshevik revolution, approximately 2.5 million deaths were recorded.
Typhus was latent in Russia long before the World War I. The mortality rate
rose from 0.13 per 1,000 in peacetime to 2.33 per 1,000 in 1915. Typhus was
imported and propagated throughout the country through the soldiers and
refugees. During the brutal winter of 1917–18, the biggest outbreak of typhus of
modern history began in a Russia that was already devastated by famine and war
resulting in five million deaths in Russia and Eastern Europe.

WORLD WAR II: Henrique da Rocha Lima, a Brazilian doctor,
discovered the cause of epidemic typhus in 1916 while doing research in Germany.
The discovery by Cox (1938) that R.
prowazekii could be grown in the yolk sac of developing chick
embryos made it possible to prepare an Epidemic Typhus vaccine, consisting of a
killed suspension of R. prowazekii grown in chick embryo. Even though
delousing station were set up and a typhus vaccine was developed, typhus
epidemics continued to seek its victims, especially in German concentration camps during the Holocaust, where typhus
was a major scourge (Anne Frank died in a camp at age 15 from typhus) and it
will never be known how many inmates succumbed to the disease. Upon the
liberation of Buchenwald, it was discovered that over 8,000 inmates were
suffering from typhus. Major typhus outbreaks occurred throughout Germany
during the course of the war. With statistical data available in 1945 16,000
cases of typhus were revealed in that year. Japan, also was afflicted by the
scourge of typhus during World War II, with approximately 45,000 cases.

 The
U.S. Army, which had been vaccinated for typhus and had good amount of supplies
of DDT available, set up many delousing to keep the disease from spreading, that
proved to be largely successful. The historical role played by Epidemic Typhus
in World War II, therefore, due to the mass of research on its prevention and
control by Cox, Durand, and others, became largely a matter of introducing and
refining methods for its control in military and civilian populations so as to
minimize its impact.

Typhus is now considered to
be endemic only in specific few areas of the world, including Eastern Africa
and South and Central America. No vaccines are currently available to prevent
typhus (Cox vaccine was ineffective), but improved hygienic practices, improved
insecticides, and antibiotics have made it easier to combat the disease and the
vector that spread it. Only
a few epidemics (Africa, Middle East, Eastern Europe, and Asia) have occurred
since then. Because of toxicity, DDT has been banned in the U.S. since 1972.

DIAGNOSIS: The diagnosis involves identification of the
bacterial genus and species by PCR testing of a skin
biopsy from
skin rash or lesions, or blood samples. Immunohistological staining identifies
the bacteria within infected tissue (skin tissue, usually). Typhus can also be
diagnosed, usually late or after the disease has been treated with antibiotics,
when significant titers of anti-rickettsial antibodies are detected by
immunological techniques.

TREATMENT: Antibiotics are commonly used to treat the
disease including doxycycline, the most preferred treatment.
Chloramphenicol, for those not pregnant or breastfeeding. ciprofloxacin is used for adults as a
substitute for doxycycline.

CONCLUSION:
After centuries of war when typhus played a
leading role in the mortality, the disease has finally been suppressed. It
is therefore evident from this paper, that an inestimable amount of History has
been impacted by Man’s contact with the body louse and the pathogens it
harbours that can never be estimated in its true sense, for historical facts
and statistical data are rather pale shadows of the impact of typhus. Indeed,
the spectacular advances of science have successfully relegated typhus to a
pestilence of yesteryear. However, the World Health Organization still
describes it as a “disease under surveillance”. The eradication of
poverty, famine, and warfare are a priority. Yet one cannot help but wonder if
the truly salient feature of Man’s encounter with louse-borne typhus is not its
effects on Man’s continual struggle to overcome his enemies, but rather the
opportunity afforded to those in retrospect to feel the humility necessary for
the survival of our species in a world of which we are, of necessity, but a
small part.