{"title":"Typhoid fever: a continuing problem","authors":"S. Newsom","doi":"10.1177/14690446070080020501","DOIUrl":null,"url":null,"abstract":"Introduction Typhoid or enteric fever has been known for centuries – although the final stages of the illness (the typhoid state) are almost indistinguishable from those of typhus fever, another scourge of the ancient world. The Emperor Augustus who as we saw was cured by his Greek doctor (Antonius Musa) was said to have had typhoid. Queen Victoria’s husband Albert was among many notables who died of the disease. The clinical picture of epidemic typhoid was documented by Thomas Willis (better known for describing the ‘circle of Willis’ formed by cerebral blood vessels) in 1659. The worldwide incidence is estimated at six million cases, with 600,000 deaths a year – mainly in Africa and Asia. Like polio and cholera, it is a strictly human infection, and spread via the faecal-oral route. The Communicable Disease Surveillance Centre (CDSC) recorded only 248 cases in England and Wales in 2006, 122 of which were imported, reflecting the value of good sanitation (recently awarded the most important advance in health since 1840 by readers of the British Medical Journal – out of 15 ‘medical milestones’). Such improvements are within living memory as my grandmother died of typhoid in 1940. My interest in the epidemiology was sparked off in 1946, when by chance we drove through Aberystwyth on the very day an outbreak started – spread by ice cream. Luckily for me, we didn’t stop. The reservoir of infection is the human carrier (a word first used by Robert Koch – typhusbazillentrgerin). Carriers may have recovered from the disease, or be entirely ‘silent’. Carriage can persist for ages. Four senior officers planning the D-Day invasion of France in 1944 who went to stay at the pub in a remote Devon village caught typhoid. The organism was of an unusual type, last seen in the Boer War 40 years earlier. Investigation revealed a veteran of that war living nearby, and sewage from his house entered an open drain that passed in front of the pub. The most famous carrier was Mary Mellon, immortalised in The ballad of Typhoid Mary (see later). Carriers can excrete large numbers of bacilli – one in Islington produced enough to be detected at the north London sewage outfall.","PeriodicalId":265443,"journal":{"name":"British Journal of Infection Control","volume":"121 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2007-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"British Journal of Infection Control","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/14690446070080020501","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 1
Abstract
Introduction Typhoid or enteric fever has been known for centuries – although the final stages of the illness (the typhoid state) are almost indistinguishable from those of typhus fever, another scourge of the ancient world. The Emperor Augustus who as we saw was cured by his Greek doctor (Antonius Musa) was said to have had typhoid. Queen Victoria’s husband Albert was among many notables who died of the disease. The clinical picture of epidemic typhoid was documented by Thomas Willis (better known for describing the ‘circle of Willis’ formed by cerebral blood vessels) in 1659. The worldwide incidence is estimated at six million cases, with 600,000 deaths a year – mainly in Africa and Asia. Like polio and cholera, it is a strictly human infection, and spread via the faecal-oral route. The Communicable Disease Surveillance Centre (CDSC) recorded only 248 cases in England and Wales in 2006, 122 of which were imported, reflecting the value of good sanitation (recently awarded the most important advance in health since 1840 by readers of the British Medical Journal – out of 15 ‘medical milestones’). Such improvements are within living memory as my grandmother died of typhoid in 1940. My interest in the epidemiology was sparked off in 1946, when by chance we drove through Aberystwyth on the very day an outbreak started – spread by ice cream. Luckily for me, we didn’t stop. The reservoir of infection is the human carrier (a word first used by Robert Koch – typhusbazillentrgerin). Carriers may have recovered from the disease, or be entirely ‘silent’. Carriage can persist for ages. Four senior officers planning the D-Day invasion of France in 1944 who went to stay at the pub in a remote Devon village caught typhoid. The organism was of an unusual type, last seen in the Boer War 40 years earlier. Investigation revealed a veteran of that war living nearby, and sewage from his house entered an open drain that passed in front of the pub. The most famous carrier was Mary Mellon, immortalised in The ballad of Typhoid Mary (see later). Carriers can excrete large numbers of bacilli – one in Islington produced enough to be detected at the north London sewage outfall.