Typhoid Fever

Typhoid Fever, a bacterial disease spread by fecal contamination of food or water. Untreated, its course takes about four weeks, with 10 percent of patients dying. Typhoid has symptoms in common with several other diseases, and only in the 1830s was it distinguished from typhus (a disease of different etiology, but with a similar clinical picture). Historians credit William Wood Gerhard of Philadelphia with having established typhoid as a specific disease in 1837.

Typhoid has been present in America at least since the early seventeenth century, when it virtually depopulated Jamestown, Virginia. Nineteenth‐century epidemiological studies consistently confirmed the British finding in 1856 that typhoid is waterborne; and years before German bacteriologists identified the pathogen in early 1880s, the experience of several cities demonstrated that water filtration reduced typhoid incidence. By 1920, when almost all American municipal water supplies were filtered, public‐health advocates were pointing to the dramatic decline of typhoid as evidence that governmental action could lessen sickness and reduce mortality.

Typhoid decimated army camps during the Civil War and again in the Spanish‐American War, when cases were typically misdiagnosed as malaria and treated futilely with quinine. With death rates in the camps over five times battlefield mortality, the army commissioned an investigation by Walter Reed, Victor Vaughan, and Edward O. Shakespeare. Concluding that typhoid was responsible, they recommended strict sanitary control of camps—a reform that led to a significantly healthier army in World War I.

The importance of healthy carriers and of tainted food in the transmission of typhoid was underscored by the case of Mary Mallon (“Typhoid Mary”), a cook in New York City. First identified as responsible for an outbreak in 1906, Mallon eventually was incarcerated to prevent her from working in the food trades.

Although a vaccine of limited efficacy exists, the principal protection against typhoid remains a pure water supply and stringent enforcement of food‐handling regulations. By the late twentieth century, almost all typhoid cases reported in the United States were contracted during visits to less‐developed countries. The exceptions, such as the 1973 outbreak in a Florida migrant labor camp, were quickly traced to breakdowns in the separation of sewage from food and water. With antibiotics, recovery takes three or four days and the mortality rate is negligible.
See also Medicine: Colonial Era; Medicine: From 1776 to the 1870s; Medicine: From the 1870s to 1945.

Bibliography

Michael P. McCarthy , Typhoid and the Politics of Public Health in Nineteenth‐Century Philadelphia, 1987.
Judith Walzer Leavitt , Typhoid Mary: Captive to the Public Health, 1996

Edward T. Morman