Typhus

Typhus

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Encyclopedia
Epidemic typhus is a form of typhus
Typhus
Epidemic typhus is a form of typhus so named because the disease often causes epidemics following wars and natural disasters...

 so named because the disease often causes epidemics following wars and natural disasters. The causative organism is Rickettsia prowazekii
Rickettsia prowazekii
Rickettsia prowazekii is a species of gram negative, Alpha Proteobacteria, obligate intracellular parasitic, aerobic bacteria that is the etiologic agent of epidemic typhus, transmitted in the feces of lice. In North America, the main reservoir for R. prowazekii is the flying squirrel. R...

, transmitted by the human body louse (Pediculus humanus corporis). Feeding on a human who carries the bacillus infects the louse. R. prowazekii grows in the louse's gut and is excreted in its feces
Feces
Feces, faeces, or fæces is a waste product from an animal's digestive tract expelled through the anus or cloaca during defecation.-Etymology:...

. The disease is then transmitted to an uninfected human who scratches the louse bite (which itches) and rubs the feces into the wound. The incubation period
Incubation period
Incubation period is the time elapsed between exposure to a pathogenic organism, a chemical or radiation, and when symptoms and signs are first apparent...

 is one to two weeks. R. prowazekii can remain viable and virulent in the dried louse feces for many days. Typhus will eventually kill the louse, though the disease will remain viable for many weeks in the dead louse.

Signs and symptoms


Symptoms include severe headache, a sustained high fever, cough, rash
Rash
A rash is a change of the skin which affects its color, appearance or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell and may be painful. The causes, and...

, severe muscle pain, chills, falling blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...

, stupor
Stupor
Stupor is the lack of critical cognitive function and level of consciousness wherein a sufferer is almost entirely unresponsive and only responds to base stimuli such as pain. This is often mistaken for delirium and treated with Haldol and or other anti-psychotic drugs...

, sensitivity to light, and delirium
Delirium
Delirium or acute confusional state is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional deficits and generalized severe disorganization of behavior...

. A rash begins on the chest about five days after the fever appears, and spreads to the trunk and extremities. A symptom common to all forms of typhus is a fever which may reach 39 °C (102°F).

Brill-Zinsser disease, first described by Nathan Brill in 1913 at Mount Sinai Hospital
Mount Sinai Hospital, New York
Mount Sinai Hospital, founded in 1852, is one of the oldest and largest teaching hospitals in the United States. In 2011-2012, Mount Sinai Hospital was ranked as one of America's best hospitals by U.S...

 in New York City
New York City
New York is the most populous city in the United States and the center of the New York Metropolitan Area, one of the most populous metropolitan areas in the world. New York exerts a significant impact upon global commerce, finance, media, art, fashion, research, technology, education, and...

, is a mild form of epidemic typhus which recurs in someone after a long period of latency (similar to the relationship between chickenpox
Chickenpox
Chickenpox or chicken pox is a highly contagious illness caused by primary infection with varicella zoster virus . It usually starts with vesicular skin rash mainly on the body and head rather than at the periphery and becomes itchy, raw pockmarks, which mostly heal without scarring...

 and shingles). This recurrence often occurs in times of relative immunosuppression
Immunosuppression
Immunosuppression involves an act that reduces the activation or efficacy of the immune system. Some portions of the immune system itself have immuno-suppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reaction to treatment of other...

, which is often in the context of malnutrition and other illnesses. In combination with poor sanitation and hygiene which leads to a greater density of lice, this reactivation is why typhus forms epidemics in times of social chaos and upheaval.

Transmission


Epidemic typhus is thus found most frequently during times of war and deprivation. For example, typhus killed hundreds of thousands of prisoners in Nazi
Nazi Germany
Nazi Germany , also known as the Third Reich , but officially called German Reich from 1933 to 1943 and Greater German Reich from 26 June 1943 onward, is the name commonly used to refer to the state of Germany from 1933 to 1945, when it was a totalitarian dictatorship ruled by...

 concentration camps during World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...

. The deteriorating quality of hygiene in camps such as Theresienstadt and Bergen-Belsen
Bergen-Belsen concentration camp
Bergen-Belsen was a Nazi concentration camp in Lower Saxony in northwestern Germany, southwest of the town of Bergen near Celle...

 created conditions where diseases such as typhus flourished. Situations in the twenty-first century with potential for a typhus epidemic would include refugee camps during a major famine or natural disaster.

Henrique da Rocha Lima
Henrique da Rocha Lima
Henrique da Rocha Lima was a Brazilian physician, pathologist and infectologist. He discovered Rickettsia prowazekii, the pathogen of epidemic typhus. Rickettsia prowazekii was named after German zoologist Stanislaus von Prowazek.Henrique da Rocha Lima received his M.D. degree from the Medical...

 in 1916 then proved that the bacterium Rickettsia prowazekii was the agent responsible for typhus; he named it after H. T. Ricketts and Stanislaus von Prowazek
Stanislaus von Prowazek
Stanislaus Josef Mathias von Prowazek, Edler von Lanow , born Stanislav Provázek, was a Czech zoologist and parasitologist, who along with pathologist Henrique da Rocha Lima discovered the pathogen of epidemic typhus.Prowazek had studied epidemic typhus in Serbia and Istanbul...

, two zoologists who died investigating a typhus epidemic in a prison camp in 1915. Once these crucial facts were recognized, Rudolf Weigl
Rudolf Weigl
Professor Rudolf Stefan Weigl was a famous Polish biologist and inventor of the first effective vaccine against epidemic typhus. Weigl founded the Weigl Institute in Lwów, Poland , where he did his vaccine-producing research.Of Austrian ethnic descent, Weigl was born in Přerov, Moravia...

 in 1930 was able to fashion a practical and effective vaccine production method by grinding up the insides of infected lice that had been drinking blood. It was, however, very dangerous to produce, and carried a high likelihood of infection to those who were working on it.

A safer mass-production
Mass production
Mass production is the production of large amounts of standardized products, including and especially on assembly lines...

-ready method using egg yolk
Egg yolk
An egg yolk is a part of an egg which feeds the developing embryo. The egg yolk is suspended in the egg white by one or two spiral bands of tissue called the chalazae...

s was developed by Herald R. Cox
H. R. Cox
Herald Rea Cox was an American bacteriologist. Born in Terre Haute, Indiana, he graduated from Indiana State Normal School, now Indiana State University, in 1928 before obtaining his doctorate from the Johns Hopkins Bloomberg School of Public Health....

 in 1938. This vaccine was widely available and used extensively by 1943.

Treatment


The infection is treated with antibiotics. Intravenous fluids and oxygen
Oxygen
Oxygen is the element with atomic number 8 and represented by the symbol O. Its name derives from the Greek roots ὀξύς and -γενής , because at the time of naming, it was mistakenly thought that all acids required oxygen in their composition...

 may be needed to stabilize the patient. The mortality rate is 10% to 60%, but is vastly lower (close to zero) if intracellular antibiotics such as tetracycline are used before 8 days. Infection can also be prevented by vaccination.

History



The first description of typhus was probably given in 1083 at a convent near Salerno
Salerno
Salerno is a city and comune in Campania and is the capital of the province of the same name. It is located on the Gulf of Salerno on the Tyrrhenian Sea....

, Italy
Italy
Italy , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...

. In 1546, Girolamo Fracastoro
Girolamo Fracastoro
Girolamo Fracastoro was an Italian physician, poet, and scholar in mathematics, geography and astronomy. Fracastoro subscribed to the philosophy of atomism, and rejected appeals to hidden causes in scientific investigation....

, a Florentine physician, described typhus in his famous treatise on viruses and contagion, De Contagione et Contagiosis Morbis.

Before a vaccine was developed in World War II, typhus was a devastating disease for humans and has been responsible for a number of epidemics throughout history. These epidemics tend to follow wars, famine
Famine
A famine is a widespread scarcity of food, caused by several factors including crop failure, overpopulation, or government policies. This phenomenon is usually accompanied or followed by regional malnutrition, starvation, epidemic, and increased mortality. Every continent in the world has...

, and other conditions that result in mass casualties.

During the second year of the Peloponnesian War
Peloponnesian War
The Peloponnesian War, 431 to 404 BC, was an ancient Greek war fought by Athens and its empire against the Peloponnesian League led by Sparta. Historians have traditionally divided the war into three phases...

 (430 BC
430 BC
Year 430 BC was a year of the pre-Julian Roman calendar. At the time, it was known as the Year of the Consulship of Crassus and Iullus...

), the city-state
City-state
A city-state is an independent or autonomous entity whose territory consists of a city which is not administered as a part of another local government.-Historical city-states:...

 of Athens
History of Athens
Athens is one of the oldest named cities in the world, having been continuously inhabited for at least 7000 years. Situated in southern Europe, Athens became the leading city of Ancient Greece in the first millennium BCE and its cultural achievements during the 5th century BCE laid the foundations...

 in ancient Greece
Greece
Greece , officially the Hellenic Republic , and historically Hellas or the Republic of Greece in English, is a country in southeastern Europe....

 was hit by a devastating epidemic, known as the Plague of Athens
Plague of Athens
The Plague of Athens was a devastating epidemic which hit the city-state of Athens in ancient Greece during the second year of the Peloponnesian War , when an Athenian victory still seemed within reach. It is believed to have entered Athens through Piraeus, the city's port and sole source of food...

, which killed, among others, Pericles
Pericles
Pericles was a prominent and influential statesman, orator, and general of Athens during the city's Golden Age—specifically, the time between the Persian and Peloponnesian wars...

 and his two elder sons. The plague returned twice more, in 429 BC and in the winter of 427/6 BC. Epidemic typhus is a strong candidate for the cause of this disease outbreak, supported by both medical and scholarly opinions.

Typhus also arrived in Europe with soldiers who had been fighting on Cyprus
Cyprus
Cyprus , officially the Republic of Cyprus , is a Eurasian island country, member of the European Union, in the Eastern Mediterranean, east of Greece, south of Turkey, west of Syria and north of Egypt. It is the third largest island in the Mediterranean Sea.The earliest known human activity on the...

. The first reliable description of the disease appears during the Spanish siege of Moorish Granada
Granada
Granada is a city and the capital of the province of Granada, in the autonomous community of Andalusia, Spain. Granada is located at the foot of the Sierra Nevada mountains, at the confluence of three rivers, the Beiro, the Darro and the Genil. It sits at an elevation of 738 metres above sea...

 in 1489. These accounts include descriptions of fever and red spots over arms, back and chest, progressing to delirium, gangrenous sores, and the stench 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. Gaol fever often occurs when prisoners are frequently huddled together in dark, filthy rooms. 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
Oxford
The city of Oxford is the county town of Oxfordshire, England. The city, made prominent by its medieval university, has a population of just under 165,000, with 153,900 living within the district boundary. It lies about 50 miles north-west of London. The rivers Cherwell and Thames run through...

 in 1577, later deemed the Black Assize
Black Assize
The Black Assize was a plague of Epidemic typhus that struck the town of Oxford in England on July 6, 1577. About 300 people including the chief baron and sheriff, are thought to have died as a result of the plague...

, over 300 died from Epidemic typhus, including Sir Robert Bell
Sir Robert Bell (Knight)
Sir Robert Bell SL of Beaupre Hall, Norfolk, was a Speaker of the House of Commons , who served during the reign of Queen Elizabeth I....

 Lord Chief Baron of the Exchequer. The outbreak that followed, between 1577 to 1579, killed about 10% of the English
English people
The English are a nation and ethnic group native to England, who speak English. The English identity is of early mediaeval origin, when they were known in Old English as the Anglecynn. England is now a country of the United Kingdom, and the majority of English people in England are British Citizens...

 population. During the Lent Assize Court held at Taunton
Taunton
Taunton is the county town of Somerset, England. The town, including its suburbs, had an estimated population of 61,400 in 2001. It is the largest town in the shire county of Somerset....

 (1730) typhus caused the death of the Lord Chief Baron
Lord Chief Baron of the Exchequer
The Chief Baron of the Exchequer was the first "baron" of the English Exchequer of pleas. "In the absence of both the Treasurer of the Exchequer or First Lord of the Treasury, and the Chancellor of the Exchequer, it was he who presided in the equity court and answered the bar i.e...

, as well as the High Sheriff
High Sheriff of Somerset
The Office of High Sheriff of Somerset is an ancient High Sheriff title which has been in existence for over one thousand years. The position was once a powerful position responsible for collecting taxes and enforcing law and order in Somerset a county in South West England. In modern times the...

, the sergeant, and hundreds of others. During a time when there were 241 capital offences, more prisoners died from 'gaol fever' than were put to death by all the public executioners in the realm. In 1759 an English authority estimated that each year a quarter of the prisoners had died from gaol fever. In London
London
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...

, typhus frequently broke out among the ill-kept prisoners of Newgate Gaol and then moved into the general city population.

Epidemics occurred throughout Europe everyday sence 1940, and occurred during the English Civil War
English Civil War
The English Civil War was a series of armed conflicts and political machinations between Parliamentarians and Royalists...

, the Thirty Years' War
Thirty Years' War
The Thirty Years' War was fought primarily in what is now Germany, and at various points involved most countries in Europe. It was one of the most destructive conflicts in European history....

 and the Napoleonic Wars
Napoleonic Wars
The Napoleonic Wars were a series of wars declared against Napoleon's French Empire by opposing coalitions that ran from 1803 to 1815. As a continuation of the wars sparked by the French Revolution of 1789, they revolutionised European armies and played out on an unprecedented scale, mainly due to...

. During Napoleon's retreat from Moscow
Moscow
Moscow is the capital, the most populous city, and the most populous federal subject of Russia. The city is a major political, economic, cultural, scientific, religious, financial, educational, and transportation centre of Russia and the continent...

 in 1812, more French
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...

 soldiers died of typhus than were killed by the Russia
Russia
Russia or , officially known as both Russia and the Russian Federation , is a country in northern Eurasia. It is a federal semi-presidential republic, comprising 83 federal subjects...

ns. A major epidemic occurred in Ireland
Ireland
Ireland is an island to the northwest of continental Europe. It is the third-largest island in Europe and the twentieth-largest island on Earth...

 between 1816–19, and 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, since 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
Franklin Pierce
Franklin Pierce was the 14th President of the United States and is the only President from New Hampshire. Pierce was a Democrat and a "doughface" who served in the U.S. House of Representatives and the Senate. Pierce took part in the Mexican-American War and became a brigadier general in the Army...

 in Concord, New Hampshire
Concord, New Hampshire
The city of Concord is the capital of the state of New Hampshire in the United States. It is also the county seat of Merrimack County. As of the 2010 census, its population was 42,695....

 in 1843 and struck in Philadelphia in 1837. Several epidemics occurred in Baltimore, Memphis
Memphis, Tennessee
Memphis is a city in the southwestern corner of the U.S. state of Tennessee, and the county seat of Shelby County. The city is located on the 4th Chickasaw Bluff, south of the confluence of the Wolf and Mississippi rivers....

 and Washington DC between 1865 and 1873. Typhus fever 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 is a completely different disease from typhus.

During World War I
World War I
World War I , which was predominantly called the World War or the Great War from its occurrence until 1939, and the First World War or World War I thereafter, was a major war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918...

 typhus caused three million deaths in Russia and more in Poland
Poland
Poland , officially the Republic of Poland , is a country in Central Europe bordered by Germany to the west; the Czech Republic and Slovakia to the south; Ukraine, Belarus and Lithuania to the east; and the Baltic Sea and Kaliningrad Oblast, a Russian exclave, to the north...

 and Romania
Romania
Romania is a country located at the crossroads of Central and Southeastern Europe, on the Lower Danube, within and outside the Carpathian arch, bordering on the Black Sea...

. Delousing 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 a civil war
Russian Civil War
The Russian Civil War was a multi-party war that occurred within the former Russian Empire after the Russian provisional government collapsed to the Soviets, under the domination of the Bolshevik party. Soviet forces first assumed power in Petrograd The Russian Civil War (1917–1923) was a...

 between the White and Red armies
Red Army
The Workers' and Peasants' Red Army started out as the Soviet Union's revolutionary communist combat groups during the Russian Civil War of 1918-1922. It grew into the national army of the Soviet Union. By the 1930s the Red Army was among the largest armies in history.The "Red Army" name refers to...

, typhus killed three million, largely civilians.
During World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...

 typhus struck the German army
German Army
The German Army is the land component of the armed forces of the Federal Republic of Germany. Following the disbanding of the Wehrmacht after World War II, it was re-established in 1955 as the Bundesheer, part of the newly formed West German Bundeswehr along with the Navy and the Air Force...

 as it invaded Russia in 1941. In 1942 and 1943 typhus hit French North Africa, Egypt
Egypt
Egypt , officially the Arab Republic of Egypt, Arabic: , is a country mainly in North Africa, with the Sinai Peninsula forming a land bridge in Southwest Asia. Egypt is thus a transcontinental country, and a major power in Africa, the Mediterranean Basin, the Middle East and the Muslim world...

 and Iran
Iran
Iran , officially the Islamic Republic of Iran , is a country in Southern and Western Asia. The name "Iran" has been in use natively since the Sassanian era and came into use internationally in 1935, before which the country was known to the Western world as Persia...

 particularly hard. Typhus epidemics killed inmates in the Nazi Germany concentration camps
Nazi concentration camps
Nazi Germany maintained concentration camps throughout the territories it controlled. The first Nazi concentration camps set up in Germany were greatly expanded after the Reichstag fire of 1933, and were intended to hold political prisoners and opponents of the regime...

; infamous pictures of typhus victims' mass graves can be seen in footage shot at Bergen-Belsen concentration camp. Thousands of prisoners held in appalling conditions in Nazi concentration camps such Theresienstadt and Bergen-Belsen also died of typhus during World War II, including Anne Frank
Anne Frank
Annelies Marie "Anne" Frank is one of the most renowned and most discussed Jewish victims of the Holocaust. Acknowledged for the quality of her writing, her diary has become one of the world's most widely read books, and has been the basis for several plays and films.Born in the city of Frankfurt...

 at the age of 15 and her sister Margot. Even larger epidemics in the post-war chaos of Europe were only averted by the widespread use of the newly discovered DDT
DDT
DDT is one of the most well-known synthetic insecticides. It is a chemical with a long, unique, and controversial history....

 to kill the lice on millions of refugees and displaced persons.

Following the development of a vaccine during World War II, epidemics have usually occurred in Eastern Europe
Eastern Europe
Eastern Europe is the eastern part of Europe. The term has widely disparate geopolitical, geographical, cultural and socioeconomic readings, which makes it highly context-dependent and even volatile, and there are "almost as many definitions of Eastern Europe as there are scholars of the region"...

, the Middle East
Middle East
The Middle East is a region that encompasses Western Asia and Northern Africa. It is often used as a synonym for Near East, in opposition to Far East...

 and parts of Africa.

Biological weapon


Typhus was one of more than a dozen agents that the United States researched as potential biological weapons before President Richard Nixon suspended all non-defensive aspects of the U.S. biological weapons program in 1969.

Literature


  • (1847) In Jane Eyre
    Jane Eyre
    Jane Eyre is a novel by English writer Charlotte Brontë. It was published in London, England, in 1847 by Smith, Elder & Co. with the title Jane Eyre. An Autobiography under the pen name "Currer Bell." The first American edition was released the following year by Harper & Brothers of New York...

    by Charlotte Brontë
    Charlotte Brontë
    Charlotte Brontë was an English novelist and poet, the eldest of the three Brontë sisters who survived into adulthood, whose novels are English literature standards...

    , an outbreak of typhus occurs in Jane's school Lowood, highlighting the unsanitary conditions the girls live in.
  • (1862) In Fathers and Sons
    Fathers and Sons
    Fathers and Sons is an 1862 novel by Ivan Turgenev, his best known work. The title of this work in Russian is Отцы и дети , which literally means "Fathers and Children"; the work is often translated to Fathers and Sons in English for reasons of euphony.- Historical context and notes :The fathers...

    by Ivan Turgenev
    Ivan Turgenev
    Ivan Sergeyevich Turgenev was a Russian novelist, short story writer, and playwright. His first major publication, a short story collection entitled A Sportsman's Sketches, is a milestone of Russian Realism, and his novel Fathers and Sons is regarded as one of the major works of 19th-century...

    , Evgeny Bazarov dissects a local peasant and dies after contracting typhus.
  • (1886) In the short story
    Short story
    A short story is a work of fiction that is usually written in prose, often in narrative format. This format tends to be more pointed than longer works of fiction, such as novellas and novels. Short story definitions based on length differ somewhat, even among professional writers, in part because...

     Excellent People by Anton Chekhov
    Anton Chekhov
    Anton Pavlovich Chekhov was a Russian physician, dramatist and author who is considered to be among the greatest writers of short stories in history. His career as a dramatist produced four classics and his best short stories are held in high esteem by writers and critics...

    , typhus kills a Russia
    Russia
    Russia or , officially known as both Russia and the Russian Federation , is a country in northern Eurasia. It is a federal semi-presidential republic, comprising 83 federal subjects...

    n provincial.
  • (1890) In How the Other Half Lives
    How the Other Half Lives
    How the Other Half Lives: Studies Among the Tenements of New York was an early publication of photojournalism by Jacob Riis, documenting squalid living conditions in New York City slums in the 1880s...

    by Jacob Riis
    Jacob Riis
    Jacob August Riis was a Danish American social reformer, "muckraking" journalist and social documentary photographer. He is known for using his photographic and journalistic talents to help the impoverished in New York City; those impoverished New Yorkers were the subject of most of his prolific...

    , the effects of typhus fever and smallpox on "Jewtown" are described.
  • (1922) Lisa, the main character in the novel Letter from an Unknown Woman
    Letter from an Unknown Woman
    Letter from an Unknown Woman is a novella by Stefan Zweig. Published in 1922, it tells the story of an author who, while reading a letter written by a woman he does not remember, gets glimpses into her life story.- Film :...

    by Stefan Zweig
    Stefan Zweig
    Stefan Zweig was an Austrian novelist, playwright, journalist and biographer. At the height of his literary career, in the 1920s and 1930s, he was one of the most famous writers in the world.- Biography :...

    , contracts typhus, along with her son, and she writes her lost love the titular letter from a hospital ward before dying.
  • (1940) in The Don Flows Home to the Sea
    The Don Flows Home to the Sea
    The Don Flows Home to the Sea is the second in the series of the great Don epic written by Mikhail Sholokhov. It originally appeared in serialized form between 1928 and 1940...

     by Mikhail Sholokhov, numerous characters contract typhus during the Russian Civil War
    Russian Civil War
    The Russian Civil War was a multi-party war that occurred within the former Russian Empire after the Russian provisional government collapsed to the Soviets, under the domination of the Bolshevik party. Soviet forces first assumed power in Petrograd The Russian Civil War (1917–1923) was a...

    .
  • (1946) In Viktor Frankl
    Viktor Frankl
    Viktor Emil Frankl M.D., Ph.D. was an Austrian neurologist and psychiatrist as well as a Holocaust survivor. Frankl was the founder of logotherapy, which is a form of Existential Analysis, the "Third Viennese School of Psychotherapy"...

    's Man's Search for Meaning
    Man's Search for Meaning
    Man's Search for Meaning is a 1946 book by Viktor Frankl chronicling his experiences as a concentration camp inmate and describing his psychotherapeutic method of finding a reason to live...

    , Frankl, a Nazi concentration camp prisoner and trained psychiatrist, treats fellow prisoners for delirium due to typhus, whilst being an on-again, off-again sufferer himself.
  • (1955) In Vladimir Nabokov
    Vladimir Nabokov
    Vladimir Vladimirovich Nabokov was a multilingual Russian novelist and short story writer. Nabokov wrote his first nine novels in Russian, then rose to international prominence as a master English prose stylist...

    's Lolita
    Lolita
    Lolita is a novel by Vladimir Nabokov, first written in English and published in 1955 in Paris and 1958 in New York, and later translated by the author into Russian...

    , Humbert Humbert's childhood sweetheart, Annabel Leigh, dies of typhus.
  • (1956) In Doctor Zhivago
    Doctor Zhivago
    -Original creation:*Doctor Zhivago, by Boris Pasternak, published in 1957**Yuri Andreyevich Zhivago, a fictional character and the main protagonist of the book Doctor Zhivago-Adaptations:There are several adaptations based on the Doctor Zhivago book:...

     by Boris Pasternak
    Boris Pasternak
    Boris Leonidovich Pasternak was a Russian language poet, novelist, and literary translator. In his native Russia, Pasternak's anthology My Sister Life, is one of the most influential collections ever published in the Russian language...

    , the main character contracts epidemic typhus in the winter following the Russian Revolution, while living in Moscow
    Moscow
    Moscow is the capital, the most populous city, and the most populous federal subject of Russia. The city is a major political, economic, cultural, scientific, religious, financial, educational, and transportation centre of Russia and the continent...

    .
  • (1973/1991) In Maus
    Maus
    Maus: A Survivor's Tale, by Art Spiegelman, is a biography of the author's father, Vladek Spiegelman, a Polish Jew and Holocaust survivor. It alternates between descriptions of Vladek's life in Poland before and during the Second World War and Vladek's later life in the Rego Park neighborhood of...

    by Art Spiegelman
    Art Spiegelman
    Art Spiegelman is an American comics artist, editor, and advocate for the medium of comics, best known for his Pulitzer Prize-winning comic book memoir, Maus. His works are published with his name in lowercase: art spiegelman.-Biography:Spiegelman was born in Stockholm, Sweden, to Polish Jews...

    , Vladek Spiegelman contracts typhus during his imprisonment at the Dachau concentration camp.
  • (c. 1974) In Little House on the Prairie
    Little House on the Prairie (TV series)
    Little House on the Prairie is an American Western drama television series, starring Michael Landon and Melissa Gilbert, about a family living on a farm in Walnut Grove, Minnesota, in the 1870s and 1880s. The show was an adaptation of Laura Ingalls Wilder's best-selling series of Little House books...

    (TV series), an outbreak of typhus hits Walnut Grove, Minnesota
    Walnut Grove, Minnesota
    As of the census of 2000, there were 599 people, 291 households, and 178 families residing in the city. The population density was 577.7 people per square mile . There were 341 housing units at an average density of 328.9 per square mile...

     killing several. It is traced to below-market-cost corn meal residents had been purchasing to avoid the high cost of the local mill
    Mill (grinding)
    A grinding mill is a unit operation designed to break a solid material into smaller pieces. There are many different types of grinding mills and many types of materials processed in them. Historically mills were powered by hand , working animal , wind or water...

    . The corn meal had been infested by rats.
  • (1978) O'Brian, Patrick
    Patrick O'Brian
    Patrick O'Brian, CBE , born Richard Patrick Russ, was an English novelist and translator, best known for his Aubrey–Maturin series of novels set in the Royal Navy during the Napoleonic Wars and centred on the friendship of English Naval Captain Jack Aubrey and the Irish–Catalan physician Stephen...

    . Desolation Island
    Desolation Island
    Desolation Island is a name that has been used for several islands. The largest and best known is Kerguelen Island in the Indian Ocean.-Places:* Desolación Island, Chile.* Desolation Island ....

    Fictional presentation of typhus - while sailing aboard the Leopard an outbreak of 'gaol-fever' strikes the crew.
  • (1935/2000) Hans Zinsser
    Hans Zinsser
    Hans Zinsser was an American bacteriologist and a prolific author. The son of German immigrants, Zinsser was born in New York City in 1878. Zinsser received his undergraduate degree from Columbia University in 1899 and completed both a masters degree and a doctorate in medicine there in 1903...

    , Rats, Lice and History although a touch outdated on the science, contains many useful cross-references to classical and historical impact of typhus.
  • (1945), The Diary of Anne Frank. Anne and her sister Margot died from typhus in Bergen-Belsen concentration camp.
  • (1996), In Andrea Barrett
    Andrea Barrett
    Andrea Barrett is an American novelist, and short story writer. Her Ship Fever collection of novella and short stories won the National Book Award in 1996...

    's novella Ship Fever the characters struggle with a typhus outbreak at the Canadian Grosse Isle Quarantine Station during 1847.
  • (2004) In Neal Stephenson
    Neal Stephenson
    Neal Town Stephenson is an American writer known for his works of speculative fiction.Difficult to categorize, his novels have been variously referred to as science fiction, historical fiction, cyberpunk, and postcyberpunk...

    's The System Of The World
    The System of the World (novel)
    The System of the World, a novel by Neal Stephenson, is the third and final volume in The Baroque Cycle.The title alludes to the third volume of Isaac Newton's Philosophiae Naturalis Principia Mathematica, which bears the same name....

    , a fictionalized Sir Isaac Newton dies of "gaol fever" before being resurrected by Daniel Waterhouse.
  • (c. 2001) In Lynn Morris's and Gilbert Morris's "Where Two Seas Met (novel)" an outbreak of Typhus on the island of Bequia in the Grenadines in 1869.
  • (2009) In The Last Will and Testament of Zephaniah Mann. Zephaniah Mann claimed to have contracted "Putrid Fever" in his will.