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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. 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 prowazeki, 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 honor 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 person-to-person transmission
may occur if the lice infects one person, who then develops the disease and the
then infected lice moves from person to person by bites and defaecation or 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 becomes
petechial and hemorrhagic, 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, as the active
stages survive only for 7-10 days without a suitable host upon which to feed
and 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 allowing the Moors to maintain their stronghold in
Granada. 

The Seventeenth Century: The Thirty Years War  (1618-1648) was also impacted tremendously after
its introduction to Typhus  during the
first 15 years of the war. Along with Plague, typhus was responsible for the death
of 10,000,000 soldiers, compared to merely 350,000 men who died in combat and was
also responsible for preventing a battle. In 1632 the armies of the Swedish
King Gustavos Adolphus and the Catholic army commander Baron Von Wallenstein

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. Despite the warnings of his medical teams, he
argued that his men could withstand the bitterest of Russian winters- which
turned out to be a fatal mistake.  As the troops marched on, food and
resources began to dwindle, forcing soldiers to rampage the peasantry who were
beset with diseases. This resulted in Epidemic Typhus being brought into the
camps along with the returning troops. The consequences were detrimental;
more than 80,000 French soldiers died within the first month of the
epidemic. Weakening the morale of soldiers. Only 90,000 French soldiers
reached Moscow out of the original army of 600,000.  The majority, as
high as 300,000, had died of Epidemic Typhus and dysentery with combat losses
amounting to less than even 100,000. With this drastic losses and the Russian
policy of Scorched Earth Plan, Napoleon was forced to retreat.

 

The declaration of war by Austria against Serbia in
1914 following the assassination of Archduke Ferdinand quickly sparked and led
to an uncontrollable global conflict named World War I.

On the Eastern Front, intense shelling of Serbian cities
destroyed the existing infrastructure and drove the population to the streets,
and at least 20,000 Austrians were taken prisoner by the Serbs. There was a
lack of physicians and other medical professionals because they had been
seconded to the army, which 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 appearance among
refugees and prisoners, and it then spread rapidly among the troops. One year
after the outbreak of hostilities, typhus killed 150,000 people, of whom 50,000
were prisoners in Serbia. A third of the country’s doctors suffered the same
fate. The mortality rate reached an epidemic peak of approximately 60 to 70%.
This dramatic situation dissuaded the Germano-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. Another
disease, described for the first time and also vectored by the body louse, was
raging in the trenches among the troops. It is caused by the bacterium
Bartonella quintana and was named trench fever.

On the Russian front, throughout the last two years of the
conflict and during the Bolshevik revolution, approximately 2.5 million deaths
were recorded. Typhus was latent in Russia long before the beginning of World
War I. The mortality rate rose from 0.13 per 1,000 in peacetime to 2.33 per
1,000 in 1915. Soldiers and refugees imported typhus and propagated it across
the country. It was during the hard winter of 1917–18 that the biggest outbreak
of typhus in modern history began in a Russia that was already devastated by
famine and war. The great epidemic started in the big cities and eventually reached
the distant lands of the Urals, Siberia and Central Asia.

After World War I, between 1919 and 1923, there were five
million deaths in Russia and Eastern Europe.

 

 

Henrique da Rocha Lima, a Brazilian doctor,
discovered the cause of epidemic typhus in 1916 while doing research on typhus
in Germany. nevertheless, still over 3 million succumbed to typhus during World
War I. Even though delousing station were set up and a typhus vaccine was
developed before World War II, typhus epidemics continued to seek its victims,
especially in German concentration camps during the Holocaust (Anne Frank died in a
camp at age 15 from typhus). Eventually, DDT was used to kill lice at the end
of World War II and 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:
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, but
improved hygienic practices, improved insecticides, and antibiotics have made
it easier to combat the disease and the vector that spread it. 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 European History has been impacted 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 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 not only political, but medical concern as
well. 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.

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