Typhus FAQ

Summary

Typhus is a louse-borne disease that killed about 1/3 of those infected, and malnutrition and disease made it worse. As almost everyone in the 17th century had lice and other insects as close personal companions, it spread easily where there was crowding of many people in close quarters - army camps were second only to prisons as ideal. It was rampant in Germany and the rest of Europe in the 1600's, and the main mode of propagation was in the wake of armies. Plague and dysentery were it's frequent companions. Typhus was known as camp fever, gaol fever, ship fever, famine fever, Irish ague, Hungarian disease (Morbus hungaricus), and many other names.

Disease Description

Typhus is more specifically known as epidemic typhus, and differentiated from murine typhus and scrub typhus. The infectious entity is Rickettsia prowazekii, a rickettsia, which is a microorganism similar in structure to a bacteria but smaller, and like a virus capable of reproducing only within a host cell. It is transmitted by the body louse Pediculus humanus, which is only found on humans and in their clothing. When a louse is infected with typhus, it dies after 2 to 3 weeks. During that time, the microorganism is present in the fine, dust-like feces of the louse. Bites by the louse do not transmit the disease; however, the action of rubbing and scratching the bites rubs the infected feces into the wound, causing infection. The feces can also be inhaled into the lungs. Once the disease is present in a human's bloodstream, it can be transmitted to the louse by it's biting.

Note: typhus killed Ricketts, after whom the class of entities is names.

The disease has an incubation period of 5 to 14 days. It first appears with rapid onset as fever and severe headache. Extreme fatigue, nausea, vomiting, and chills frequently appear. After about 4 days, a rash appears. Toxemia appears, circulation becomes sluggish, and gangrene may appear in the extremities and genitals. The victim becomes stupor us. The crisis occurs after 9 to 12 days, and about 1/3 of those infected slip into a coma and die, usually of cardiac failure, frequently with pneumonia as a complication. After 14 days, the fever may disappear and recovery follows. Recurrences are rare, milder than the initial attack, and known as Brill-Zinnser disease. Treatment by tetracycline or chloramphenicol rapidly cures the disease if caught early enough. Penicillin and sulfa drugs do not appear to have an effect, although I am not completely sure about the latter. There is also a vaccine which prevents or reduces the severity of the disease.

Due to the nature of the feces, medical personal are at severe risk of infection. So are people in epidemic regions who do laundry, and people who are employed in lodging. It is critical that clothing of those infected be carefully removed and sterilized or burned. Medical personal should wear masks, protective clothing, and even eye protection, as there are cases of transmission via the eyes.

Historical Context

There is not absolute identification of typhus as the disease in question in a number of epidemics. I am relying on the analysis by Hans Zinsser, a bacteriologist who specialized in Typhus and wrote Rats, Lice, and History. There is some disagreement as to when it first entered Europe, but the first severe epidemic was when Spanish troops returned from Crete to participate in the Grenada wars in 1489. Of the 20,000 Spanish soldiers who died by early 1490, 85% died from disease, mostly typhus. It continued to have a major impact on military conflict as late as World War I, and in many cases it was typhus and other concurrent diseases, rather than combat, that decided the course of history.

Zinsser says that "The Thirty Years' War was the most gigantic natural experiment in epidemiology to which mankind has ever been subjected". Typhus was the dominant disease before 1630, and after that plague was more significant. As troops traveled through the region, they carried these diseases with them, and the underpaid, underfed, undisciplined troops spread it to the local populations as they searched for food and money, often in barbaric ways. Typhus peaked in 1625, after Mansfield's, Tilly's, and Wallenstein's troops had left it in their wake. It hit Metz, Nuremberg, and a number of other towns and cities.

When Gustavus II Adolphus invaded, his troops acquired typhus as they traveled through Germany. "Saxony suffered severely from typhus after the battle of Breitenfeld in 1631." "Bavaria was almost depopulated at that time." When Swedish forces besieged Nuremberg in June of 1632, typhus and plague hit both sides. Thousands died near Nuremberg, and the Swedish forces suffered similarly. In addition, the starving and diseased troops plied their trade on the villages and towns near Nuremberg.

Thuringia was one of the hardest hit provinces in Germany, as were Bohemia, Saxony, and Wurtemburg. Death rates in towns throughout Germany seemed to be 2 to 3 times greater than typical, and typhus is believed to be a major contributor to this difference.

There are many more occurrences listed, especially when Europeans visited the new world.

Implications for 1632

It appears that typhus is as great a threat to Grantville, the United States, and indeed to the CPE as are invading armies - although the two go together, as invading armies are the typical vector for propagation of the disease. Indeed, if the refugees entering Grantville not been cleansed and their clothing sterilized, as much as one third of the original inhabitants might be dead - the older ones disproportionately so. It was explained to Gretchen in translation that their clothes were to be boiled - could this have been steam sterilization? It also explains the grimace that "the Duchess" makes as she submitted her clothing to be cleaned with the rest. Note that this means that anyone visiting Grantville will need to be required to have their clothing sterilized, or at least treated with long acting insecticide - but without sterilization, any infected feces could be spread by removing or changing the clothing. This is not as obvious as it seems, for there were some cases in Poland after WW I when medical teams attempted to stop an epidemic, but faced opposition from the local populate that not only was not used to bathing in winter, but feared it more than typhus. Some actually felt that the lice provided some protection from disease.

Providing these services outside of Grantville will initially require a lot of resources not yet available. There would clearly be difficulty in convincing a skeptical population of a city (such as Jena, for example) that all their clothing should be sterilized, and they should all be bathed, to kill and remove the lice, when it may run contrary to some religious beliefs, and they are not totally convinced of the louse as the cause of the disease. While I would suspect that many students in the school could be convinced, and the faculty and town elders might be, getting close to 100% coverage would be difficult - at least unless an epidemic hits one of the cities in Thuringia, and is rapidly brought under control. Remember, though, that with a 1-2 week incubation period, the disease will continue after the lice have been eradicated. And it is critical to eradicate lice from GA's army to reduce casualties, retain trained troops in the face of future invaders, and prevent troops from spreading typhus within the CPE. It also seems important to use knowledge of nutrition and food preservation technology to aid in providing adequate nutrition for GA's troops.

The two alternatives for mass removal of lice seem to be steam cleaning and mass bathing, or the application of persistent (because the eggs are long lived) insecticides, such as DDT (Jens, you were probably right to suggest DDT, even given the problems with it to the environment). DDT was first synthesized in 1874, although it's use as an insecticide was not discovered until immediately before WW II. It appears to be well within Grantville's capability to produce in some quantity, although making enough to protect all of the CPE is not immediately on the horizon. Protecting nearby towns and GA's army appears to be an immediate priority, and steam sterilization may be easier to provide. Alternative insecticides include Methoxychlor, which is less persistent than DDT and does not accumulate in fatty tissue; Benzene hexachloride is probably the easiest insecticide to synthesize, requiring the addition of chlorine to benzene (the latter extracted from oil or coal tar), and being faster acting and shorter lived than DDT, but lethal to fish in extremely low concentrations. A "natural" alternative is to grow Chrysanthemums, whose flower heads produce pyrethrum, an insecticide found in short term pet shampoos and in a non-prescription remedy for head lice. It can probably be extracted from the powdered flower heads by dissolving in an organic solvent, such as ether, followed by vacuum evaporation to remove the solvent. Or just use the powdered dried heads. It is of very short duration, however.

I already mentioned that the tetracyclines and chloramphenicol are the only antibiotics presently recommended, and that it appears from my reading that neither Penicillin nor Sulfa Drugs will significantly inhibit the disease - input from anyone with more data will be appreciated. The only obvious help is through palliative treatment, using IVs to maintain fluid levels. The tetracyclines can be produced from the right microbes, and I was told that tetracycline is "re-discovered" frequently in the search for antibiotics - but it will take a lot of luck to isolate just that one for drug production, let alone the problems with mass production of antibiotics in 1632. One point to note, however, is that the chemical formula for chloramphenicol is arguably the easiest antibiotic to synthesize, and in fact is probably the only antibiotic produced today by synthesis, containing no complex cyclics (such as Penicillin and it's derivatives). It appears to me that it is possible for someone of Greg and Jerry Trainer's expertise to synthesize - in small quantities, and in 1 to 2 years using their "copious free time". The work will mostly be in figuring out a synthesis route, purifying reagents, in getting it to work efficiently, and figuring out and correcting mistakes. Mass producing it will probably quickly use up the reagents they have available, and they will need to obtain raw materials to make the reagents needed - even those needed as catalysts, which tend to be the more difficult ones to produce. If they could produce it, it would arguably be the most valuable produced material on the planet, and chloramphenicol also works on the plague and syphilis. While I believe this to be reasonable, I don't know if the readers would feel so. That is Eric's determination. We'll see in 1634 or 1635.

Bibliography

Armies of Pestilence: The Impact of Disease on History
R.S. Bray, 1996 Find in a Library

Man and Microbes: Disease and Plagues in History and Modern Times
Arno Karle, 1995 Find in a Library

Rats, Lice, and History
Hans Zinsser, 1934 Find in a Library

The Merck Manual of Medical Information, Home Edition,
1997 Find in a Library

Encyclopedia Britannica 2001, DVD Version