Early descriptions The
plague of Athens, during the
Peloponnesian War, was most likely an outbreak of typhoid fever.
Definition and evidence of transmission The French doctors
Pierre-Fidele Bretonneau and
Pierre-Charles-Alexandre Louis are credited with describing typhoid fever as a specific disease, unique from
typhus. Both doctors performed autopsies on individuals who died in Paris due to fever – and indicated that many had lesions on the
Peyer's patches which correlated with distinct symptoms before death. British medics were skeptical of the differentiation between typhoid and typhus because both were endemic to Britain at that time. However, in France, only typhoid was present circulating in the population. Browicz was able to isolate and grow the bacilli but did not go as far as to insinuate or prove that they caused the disease. The bacterium's role in disease was speculated but not confirmed. Eberth is given credit for discovering the bacterium definitively by successfully isolating the same bacterium from 18 of 40 typhoid victims and failing to discover the bacterium present in any "control" victims of other diseases. Gaffky isolated the same bacterium as Eberth from the spleen of a typhoid victim, and was able to grow the bacterium on solid media.
Chlorination of water Most developed countries had declining rates of typhoid fever throughout the first half of the 20th century due to vaccinations and advances in public sanitation and hygiene. In 1893, attempts were made to chlorinate the water supply in
Hamburg, Germany, and in 1897
Maidstone, England, was the first town to have its entire water supply chlorinated. In 1905, following an outbreak of typhoid fever, the City of
Lincoln, England, instituted permanent water chlorination. The first permanent disinfection of drinking water in the US was made in 1908 to the
Jersey City, New Jersey, water supply. Credit for the decision to build the chlorination system has been given to
John L. Leal. The
chlorination facility was designed by
George W. Fuller. Outbreaks in traveling military groups led to the creation of the Lyster bag in 1915: a bag with a faucet that can be hung from a tree or pole, filled with water, and comes with a chlorination tablet to drop into the water. In 1899, there were 24 cases of typhoid traced to a single milkman, whose wife had died of typhoid fever a week before the outbreak. The most notorious carrier of typhoid fever, but by no means the most destructive, was
Mary Mallon, known as Typhoid Mary. Although other cases of human-to-human spread of typhoid were known at the time, the concept of an asymptomatic carrier, who was able to transmit disease, had only been hypothesized and not yet identified or proven. In recounts of Soper's pursuit of Mallon, his only remorse appears to be that he was not given enough credit for his relentless pursuit and publication of her personal identifying information, stating that the media "rob[s] me of whatever credit belongs to the discovery of the first typhoid fever carrier to be found in America." All cases were concluded to be due to a single milk farm worker, who was shedding large amounts of the typhoid pathogen in his urine. Within the same publication, the first official estimate of typhoid carriers is given: 2–5% of all typhoid patients, and distinguished between temporary carriers and chronic carriers. The
Los Angeles County department of public health tracks typhoid carriers and reports the number of carriers identified within the county yearly; between 2006 and 2016 0–4 new cases of typhoid carriers were identified per year. Carriers may be released from their agreements upon fulfilling "release" requirements, based on completion of a personalized treatment plan designed with medical professionals.
Denise Monack and
Stanley Falkow described a mouse model of asymptomatic intestinal and systemic infection in 2004, and
Monack went on to demonstrate that a subpopulation of
superspreaders are responsible for the majority of transmission to new hosts, following the
80/20 rule of disease transmission, and that the intestinal microbiota likely plays a role in transmission.
Monack's mouse model allows long-term carriage of
Salmonella in
mesenteric lymph nodes,
spleen and
liver. At that time, typhoid often killed more soldiers at war than were lost due to enemy combat. Wright further developed his vaccine at a newly opened research department at
St Mary's Hospital Medical School in London in 1902, where he established a method for measuring protective substances (
opsonin) in human blood. Wright's version of the typhoid vaccine was produced by growing the bacterium at
body temperature in broth, then heating the bacteria to 60 °C to "heat inactivate" the pathogen, killing it, while keeping the surface
antigens intact. The heat-killed bacteria was then injected into a patient. The British Army was the only combatant at the outbreak of the war to have its troops fully immunized against the bacterium. For the first time, their casualties due to combat exceeded those from disease. In 1909,
Frederick F. Russell, a
U.S. Army physician, adopted Wright's typhoid vaccine for use with the Army, and two years later, his vaccination program became the first in which an entire army was immunized. It eliminated typhoid as a significant cause of morbidity and mortality in the U.S. military. Typhoid vaccination for members of the American military became mandatory in 1911. Arthur Felix and Margaret Pitt also isolated the strain Ty2, which became the parent strain of
Ty21a, the strain used as a live-attenuated vaccine for typhoid fever today.
Antibiotics and resistance Chloramphenicol was isolated from
Streptomyces by
David Gotlieb during the 1940s. In 1948, American army doctors tested its efficacy in treating typhoid patients in
Kuala Lumpur, Malaysia. Individuals who received a full course of treatment cleared the infection, whereas patients given a lower dose had a relapse. Asymptomatic carriers continued to shed bacilli despite chloramphenicol treatment – only ill patients were improved with chloramphenicol. Resistance to chloramphenicol became frequent in Southeast Asia by the 1950s, and today chloramphenicol is only used as a last resort due to the high prevalence of resistance. ==Terminology==