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Typhus
Classification and external resources

Rash caused by epidemic typhus
ICD-10 A75.
ICD-9 080-083
DiseasesDB 29240
MedlinePlus 001363
eMedicine med/2332
MeSH D014438

Typhus is any of several similar diseases caused by Rickettsiae.[1] The name comes from the Greek typhos (τῦφος) meaning smoky or hazy, describing the state of mind of those affected with typhus. The causative organism Rickettsia is an obligate parasite and cannot survive for long outside living cells. Typhus should not be confused with typhoid fever, as the diseases are unrelated.

Multiple diseases include the word "typhus" in their description. Types include:

Condition Bacterium Arthropod Notes
Epidemic typhus Rickettsia prowazekii lice on humans When the term "typhus" is used without qualification, this is usually the condition meant. Also, historical references to "typhus" are now generally considered to be this condition.
Murine typhus or "endemic typhus" Rickettsia typhi fleas on rats -
Scrub typhus Orientia tsutsugamushi harvest mites on humans or rodents Unlike the two conditions above, though it has the word "typhus" in the name, it is currently usually not classified in the typhus group, but in the closely related spotted fever group.[2]

Contents

Symptoms

Murine typhus

  • Abdominal pain
  • Backache
  • Dull red rash that begins on the middle of the body and spreads
  • Extremely high fever (105-106 degrees Fahrenheit)
  • Hacking, dry cough
  • Headache
  • Joint pain
  • Nausea

Epidemic typhus

  • Chills
  • Cough
  • Delirium
  • High fever (104 degrees Fahrenheit)
  • Joint pain
  • Low blood pressure
  • Rash
  • Sensitivity to light
  • Severe headache
  • Severe muscle pain
  • Stupor

In human history

Civilian Public Service worker distributes rat poison for typhus control in Gulfport, Mississippi, ca. 1945.

The first reliable description of the disease appears during the Spanish siege of Moorish Granada in 1489. These accounts include descriptions of fever and red spots over arms, back and chest, progressing to delirium, gangrenous sores, and the stink of rotting flesh. During the siege, the Spaniards lost 3,000 men to enemy action but an additional 17,000 died of typhus.

Typhus was also common in prisons (and in crowded conditions where lice spread easily), where it was known as gaol fever or jail fever, and often occurs when prisoners are frequently huddled together in dark, filthy rooms. Thus, "Imprisonment until the next term of court" was often equivalent to a death sentence. It was so infectious that prisoners brought before the court sometimes infected the court itself. Following the Assize held at Oxford in 1577, later deemed the Black Assize, over 300 died from Epidemic typhus, including Sir Robert Bell Lord Chief Baron of the Exchequer. During the Lent Assize Court held at Taunton (1730) typhus caused the death of the Lord Chief Baron, as well as the High Sheriff, the sergeant, and hundreds of others. During a time when there were 241 capital offenses- more prisoners died from 'gaol fever' than were put to death by all the public executioners in the British realm. In 1759, an English authority estimated that each year a quarter of the prisoners had died from Gaol fever.[3] In London, typhus frequently broke out among the ill-kept prisoners of Newgate Gaol and then moved into the general city population.

A U.S. soldier is demonstrating DDT-hand spraying equipment. DDT was used to control the spread of typhus-carrying lice.

Epidemics occurred routinely throughout Europe from the 16th to the 19th centuries, and occurred during the English Civil War, the Thirty Years' War and the Napoleonic Wars. In the Thirty Years' War, an estimated 8 million Germans were wiped out by bubonic plague and typhus fever.[4].

During Napoleon's retreat from Moscow in 1812, more French soldiers died of typhus than were killed by the Russians.[5]

A major epidemic occurred in Ireland between 1816-19, during the famine caused by a world wide reduction in temperature known as the Year Without a Summer. It is estimated that 100,000 Irish perished. Typhus appeared again in the late 1830s, and yet another major typhus epidemic occurred during the Great Irish Famine between 1846 and 1849. The Irish typhus spread to England, where it was sometimes called "Irish fever" and was noted for its virulence. It killed people of all social classes as lice were endemic and inescapable, but it hit particularly hard in the lower or "unwashed" social strata.

In America, a typhus epidemic killed the son of Franklin Pierce in Concord, New Hampshire in 1843 and struck in Philadelphia in 1837. Several epidemics occurred in Baltimore, Memphis and Washington DC between 1865 and 1873. Typhus was also a significant killer during the US Civil War, although typhoid fever was the more prevalent cause of US Civil War "camp fever". Typhoid fever, caused by Salmonella, is a completely different disease from typhus (see chart below).

During World War I typhus caused three million deaths in Russia and more in Poland and Romania.[6] De-lousing stations were established for troops on the Western front but the disease ravaged the armies of the Eastern front, with over 150,000 dying in Serbia alone. Fatalities were generally between 10 to 40 percent of those infected, and the disease was a major cause of death for those nursing the sick. Between 1918 and 1922 typhus caused at least 3 million deaths out of 20–30 million cases. In Russia after World War I, during the civil war between the White and Red armies, typhus killed three million, largely civilians. Even larger epidemics in the post-war chaos of Europe were only averted by the widespread use of the newly discovered DDT to kill the lice on millions of refugees and displaced persons.

Typhus epidemics killed inmates in the Nazi Germany concentration camps; infamous pictures of typhus victims' mass graves can be seen in footage shot at Bergen-Belsen concentration camp.[7] Thousands of prisoners who were held in unsuitable hygiene conditions in Nazi concentration camps such Theresienstadt and Bergen-Belsen also died of typhus during World War II[7], including Anne Frank at the age of 15 and her sister Margot.

The first successful typhus vaccine was developed by the Polish zoologist Rudolf Weigl in the period between the two world wars.[8] Better, less dangerous and less expensive vaccines were developed during World War II.

Since then some epidemics have occurred in Eastern Europe, Asia, the Middle East and parts of Africa.

Contemporary Society

According to the UN WHO, typhus continues to kill approximately a weighted average of 0.2 people per million, per annum[9]. Given a global population of circa 7 billion inhabitants, this equates to a minimum of 1400 deaths per year.

Treatment

Without treatment the disease can be fatal, particularly the epidemic form. Prompt treatment with antibiotics cures nearly every patient.[10]

References

  1. ^ Typhus at Dorland's Medical Dictionary
  2. ^ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis, Mo: Elsevier Saunders. pp. 396. ISBN 0-7216-0187-1. 
  3. ^ Ralph D. Smith, Comment, Criminal Law -- Arrest -- The Right to Resist Unlawful Arrest, 7 NAT. RESOURCES J. 119, 122 n.16 (1967) (hereinafter Comment) (citing John Howard, The State of Prisons 6-7 (1929)) (Howard's observations are from 1773 to 1775). Copied from State v. Valentine May 1997 132 Wn.2d 1, 935 P.2d 1294
  4. ^ War and Pestilence. TIME
  5. ^ The Historical Impact of Epidemic Typhus. Joseph M. Conlon.
  6. ^ History of Typhus Fever
  7. ^ a b Nuernberg Military Tribunal, Volume I pp. 508-511
  8. ^ Naomi Baumslag, "Murderous medicine: Nazi doctors, human experimentation, and Typhus", Greenwood Publishing Group, 2005, pg. 133, [1]
  9. ^ WHO Statistical Information System (WHOSIS)
  10. ^ [2]

Source material

Up to date as of January 22, 2010

From Wikisource

Typhus
by Anton Chekhov, translated by S. S. Koteliansky and Gilbert Cannan


IN a smoking-compartment of the mail-train from Petrograd to Moscow sat a young lieutenant, Klimov by name. Opposite him sat an elderly man with a clean-shaven, shipmaster's face, to all appearances a well-to-do Finn or Swede, who all through the journey smoked a pipe and talked round and round the same subject.

"Ha! you are an officer! My brother is also an officer, but he is a sailor. He is a sailor and is stationed at Kronstadt. Why are you going to Moscow?"

"I am stationed there."

"Ha! I Are you married?"

"No. I live with my aunt and sister."

"My brother is also an officer, but he is married and has a wife and three children. Ha!"

The Finn looked surprised at something, smiled broadly and fatuously as he exclaimed, "Ha," and every now and then blew through the stem of his pipe. Klimov, who was feeling rather unwell, and not at all inclined to answer questions, hated him, with all his heart. He thought how good it would be to snatch his gurgling pipe out of his hands and throw it under the seat and to order the Finn himself into another car.

"They are awful people, these Finns and. . . . Greeks," he thought. "Useless, good-for-nothing, disgusting people. They only cumber the earth. What is the good of them?"

And the thought of Finns and Greeks filled him with a kind of nausea. He tried to compare them with the French and the Italians, but the idea of those races somehow roused in him the notion of organ-grinders, naked women, and the foreign oleographs which hung over the chest of drawers in his aunt's house.

The young officer felt generally out of sorts. There seemed to be no room for his arms and legs, though he had the whole seat to himself ; his mouth was dry and sticky, his head was heavy and his clouded thoughts seemed to wander at random, not only in his head, but also outside it among the seats and the people looming in the darkness. Through the turmoil in his brain, as through a dream, he heard the murmur of voices, the rattle of the wheels, the slamming of doors. Bells, whistles, conductors, the tramp of the people on the platforms came oftener than usual. The time slipped by quickly, imperceptibly, and it seemed that the train stopped every minute at a station as now and then there would come up the sound of metallic voices :

"Is the post ready?"

"Ready."

It seemed to him that the stove-heater came in too often to look at the thermometer, and that trains never stopped passing and his own train was always roaring over bridges. The noise, the whistle, the Finn, the tobacco smoke all mixed with the ominous shifting of misty shapes, weighed on Klimov like an intolerable nightmare. In terrible anguish he lifted up his aching head, looked at the lamp whose light was encircled with shadows and misty spots ; he wanted to ask for water, but his dry tongue would hardly move, and he had hardly strength enough to answer the Finn's questions. He tried to lie down more comfortably and sleep, but he did not succeed : the Finn fell asleep several times, woke up and lighted his pipe, talked to him with his "Ha!" and went to sleep again ; and the lieutenant could still not find room for his legs on the seat, and all the while the ominous figures shifted before his eyes.

At Spirov he got out to have a drink of water. He saw some people sitting at a table eating hurriedly.

"How can they eat?" he thought, trying to avoid the smell of roast meat in the air and seeing the chewing mouth, for both seemed to him utterly disgusting and made him feel sick.

A handsome lady was talking to a military man in a red cap, and she showed magnificent white teeth when she smiled; her smile, her teeth, the lady herself produced in Klimov the same impression of disgust as the ham and the fried cutlets. He could not understand how the military man in the red cap could bear to sit near her and look at her healthy smiling face.

After he had drunk some water, he went back to his place. The Finn sat and smoked. His pipe gurgled and sucked like a galoche full of holes in dirty weather.

"Ha!" he said with some surprise. ' What station is this? "

"I don't know," said Klimov, lying down and shutting his mouth to keep out the acrid tobacco smoke.

"When do we get to Tver?"

"I don't know. I am sorry, I. . . I can't talk. I am not well. I have a cold."

The Finn knocked out his pipe against the window-frame and began to talk of his brother, the sailor. Klimov paid no more attention to him and thought in agony of his soft, comfortable bed, of the bottle of cold water, of his sister Katy, who knew so well how to tuck him up and cosset him. He even smiled when there flashed across his mind his soldier-servant Pavel, taking off his heavy, close-fitting boots and putting water on the table. It seemed to him that he would only have to lie on his bed and drink some water and his nightmare would give way to a sound, healthy sleep.

"Is the post ready? " came a dull voice from a distance.

"Ready," answered a loud, bass voice almost by the very window.

It was the second or third station from Spirov.

Time passed quickly, seemed to gallop along, and there would be no end to the bells, whistles, and stops. In despair Klimov pressed his face into the corner of the cushion, held his head in his hands, and again began to think of his sister Katy and his orderly Pavel ; but his sister and his orderly got mixed up with the looming figures and whirled about and disappeared. His breath, thrown back from the cushion, burned his face, and his legs ached and a draught from the window poured into his back, but, painful though it was, he refused to change his position. . . A heavy, drugging torpor crept over him and chained his limbs.

When at length he raised his head, the car was quite light. The passengers were putting on their overcoats and moving about. The train stopped. Porters in white aprons and number-plates bustled about the passengers and seized their boxes. Klimov put on his greatcoat mechanically and left the train, and he felt as though it were not himself walking, but someone else, a stranger, and he felt that he was accompanied by the heat of the train, his thirst, and the ominous, lowering figures which all night long had prevented his sleeping. Mechanically he got his luggage and took a cab. The cabman charged him one rouble and twenty-five copecks for driving him to Povarska Street, but he did not haggle and submissively took his seat in the sledge. He could still grasp the difference in numbers, but money had no value to him whatever.

At home Klimov was met by his aunt and his sister Katy, a girl of eighteen. Katy had a copy-book and a pencil in her hands as she greeted him, and he remembered that she was preparing for a teacher's examination. He took no notice of her greetings and questions, but gasped from the heat, and walked aimlessly through the rooms until he reached his own, and then he fell prone on the bed. The Finn, the red cap, the lady with the white teeth, the smell of roast meat, the shifting spot in the lamp, filled his mind and he lost consciousness and did not hear the frightened voices near him.

When he came to himself he found himself in bed, undressed, and noticed the water-bottle and Pavel, but it did not make him any more comfortable nor easy. His legs and arms, as before, felt cramped, his tongue clove to his palate, and he could hear the chuckle of the Finn's pipe. . . By the bed, growing out of Pavel's broad back, a stout, black-bearded doctor was bustling.

"All right, all right, my lad," he murmured. "Excellent, excellent. . . .Jist so, jist so. . ."

The doctor called Klimov "my lad." Instead of "just so," he said " jist saow," and instead of "yes," "yies."

"Yies, yies, yies," he said. " Jist saow, jist saow. . . . Don't be downhearted !"

The doctor's quick, careless way of speaking, his well-fed face, and the condescending tone in which he said " my lad " exasperated Klimov.

"Why do you call me 'my lad' ' he moaned. "Why this familiarity, damn it all? "

And he was frightened by the sound of his own voice. It was so dry, weak, and hollow that he could hardly recognise it.

"Excellent, excellent," murmured the doctor, not at all offended. " Yies, yies. You musn't be cross."

And at home the time galloped away as alarmingly quickly as in the train. . . The light of day in his bedroom was every now and then changed to the dim light of evening. . . The doctor never seemed to leave the bedside, and his " Yies, yies, yies," could be heard at every moment. Through the room stretched an endless row of faces ; Pavel, the Finn, Captain Taroshevich, Sergeant Maximenko, the red cap, the lady with the white teeth, the doctor. All of them talked, waved their hands, smoked, ate. Once in broad daylight Klimov saw his regimental priest, Father Alexander, in his stole and with the host in his hands, standing by the bedside and muttering something with such a serious expression as Klimov had never seen him wear before. The lieutenant remembered that Father Alexander used to call all the Catholic officers Poles, and wishing to make the priest laugh, he exclaimed :

"Father Taroshevich, the Poles have fled to the woods."

But Father Alexander, usually a gay, light-hearted man, did not laugh and looked even more serious, and made the sign of the cross over Klimov. At night, one after the other, there would come slowly creeping in and out two shadows. They were his aunt and his sister. The shadow of his sister would kneel down and pray; she would bow to the ikon, and her grey shadow on the wall would bow, too, so that two shadows prayed to God. And all the time there was a smell of roast meat and of the Finn's pipe, but once Klimov could detect a distinct smell of incense. He nearly vomited and cried :

"Incense! Take it away."

There was no reply. He could only hear priests chanting in an undertone and some one running on the stairs.

When Klimov recovered from his delirium there was not a soul in the bedroom. The morning sun flared through the window and the drawn curtains, and a trembling beam, thin and keen as a sword, played on the water-bottle. He could hear the rattle of wheels that meant there was no more snow in the streets. The lieutenant looked at the sunbeam, at the familiar furniture and the door, and his first inclination was to laugh. His chest and stomach trembled with a sweet, happy, tickling laughter. From head to foot his whole body was filled with a feeling of infinite happiness, like that which the first man must have felt when he stood erect and beheld the world for the first time. Klimov had a passionate longing for people, movement, talk. His body lay motionless; he could only move his hands, but he hardly noticed it, for his whole attention was fixed on little things. He was delighted with his breathing and with his laughter; he was delighted with the existence of the water-bottle, the ceiling, the sun beam, the ribbon on the curtain. God's world, even in such a narrow corner as his bedroom, seemed to him beautiful, varied, great. When the doctor appeared the lieutenant thought how nice his medicine was, how nice and sympathetic the doctor was, how nice and interesting people were, on the whole.

" Yies, yies, yies," said the doctor. "Excellent, excellent. Now we are well again. Jist saow. Jist saow."

The lieutenant listened and laughed gleefully. He remembered the Finn, the lady with the white teeth, the train, and he wanted to eat and smoke.

"Doctor,"' he said, "tell them to bring me a slice of rye bread and salt, and some sardines. . ."

The doctor refused. Pavel did not obey his order and refused to go for bread. The lieutenant could not bear it and began to cry like a thwarted child.

"Ba-by," the doctor laughed. "Mamma! Hush-aby! "

Klimov also began to laugh, and when the doctor had gone, he fell sound asleep. He woke up with the same feeling of joy and happiness. His aunt was sitting by his bed.

"Oh, aunty! " He was very happy. "What has been the matter with me? "

"Typhus."

"I say! And now I am well, quite well! Where is Katy?"

"She is not at home. She has probably gone to see some one after her examination."

The old woman bent over her stocking as she said this; her lips began to tremble; she turned her face away and suddenly began to sob. In her grief, she forgot the doctor's orders and cried :

"Oh! Katy! Katy! Our angel is gone from us! She is gone!"

She dropped her stocking and stooped down for it, and her cap fell off her head. Klimov stared at her grey hair, could not understand, was alarmed for Katy, and asked :

"But where is she, aunty?"

The old woman, who had already forgotten Klimov and remembered only her grief, said :

"She caught typhus from you and . . and died. She was buried the day before yesterday."

This sudden appalling piece of news came home to Klimov's mind, but dreadful and shocking though it was it could not subdue the animal joy which thrilled through the convalescent lieutenant. He cried, laughed, and soon began to complain that he was given nothing to eat.

Only a week later, when, supported by Pavel, he walked in a dressing-gown to the window, and saw the grey spring sky and heard the horrible rattle of some old rails being carried by on a lorry, then his heart ached with sorrow and he began to weep and pressed his forehead against the window-frame.

"How unhappy I am !" he murmured. "My God, how unhappy I am!"

And joy gave way to his habitual weariness and a sense of his irreparable loss.


Simple English

Typhus is unrelated to both typhoid fever and paratyphoid fever

Typhus is the name for a number of diseases, caused by bacteria called Rickettsiae. These bacteria are parasites that cannot survive outside their host organism. Depending on the species the host organisms are, fleas (on rats), harvest mites (on several rodents and humans), or lice (on humans). When the term is commonly used, it usually means endemic typhus, which is spread by lice. The name typhus comes from Greek, where it means smoky or hazy. This was the word used to describe the state of mind the patients are in.

Typhus can be treated with antibiotics.








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