Enteric (Typhoid) Fever
In the British Medical Journal of the 7th July 1883, an article written by Surgeon Robert Vacy Ash appears based on his experiences while campaigning, in the article he discusses the causes of Enteric Fever (now known as Typhoid Fever) as follows:
It was in the days when the ranks were composed mostly of twenty one years men - men who had served for some time previously in most trying climates. Of course, there was a sprinkling of six and twelve years men: but the majority were seasoned soldiers, who had seen a good lot of service, and some of it in Malta, not the best school in the world for campaigning. The average age of the force I am unable to give: but it could not have been as low as that in Egypt (twenty four years about), for the short service had not yet become general. Taking them all round, they were as fine a body of men as I ever saw begin a march. The truth of this was borne out by the few 'casualties' on the line of march. A fortnight's marching brought us to Newcastle, on the borders of the Transvaal. Camp was pitched on a hill over looking the town, and separated there from a river of considerable size - one of those numerous rivers arising in the noble Drakensberg close by, and which intersect the colony so plentifully. A rest of three weeks or so, awaiting orders to resume march from Sir T Shepstone, was useful: and then the force set out for Pretoria, distant about two hundred and twenty miles. For the first thirty, the country traversed presented a series of mountain spurs, each ravine having it's mountain stream fresh from the hills on the left. It is quite possible that, had a microscopic examination of the water been made, algae and diatomes could have been discovered: but as Professor De Chaumont says: 'to condemn water on account of the presence of these living creatures, would be really to condemn all water, even rain'. They may therefore be said to have contained pure water. Soon however, this hilly country ceased and a flat uninteresting plain took it's place: a few stagnant pools supplanted the beautiful running mountain streams, and precautions had to be taken to prevent the men from using them. This was not difficult, as they did not suffer greatly from thirst. Night marching was resorted to; the men carried their rifles and ammunition only, and hourly halts were called. The result was little or no sickness except the usual abrasions and excoriations. Diarrhoea was almost unknown, and sunstroke absolutely so. Even on this high flat plain - 3,000 feet above the level of the sea - one of those mountain streams was met with about every ten miles, when the men could drink their full with impunity, and replenish their water bottles. I cannot imagine campaigning under more favourable circumstances. The heat certainly was great at mid-day in the bell tents; but the nights were cool - so coll, in fact, that I often marched on foot in preference to riding. A fortnight sufficed to cover the two hundred and twenty miles, and Pretoria was reached on the 4th May 1877. Our camp was pitched above and on a higher level than the town, and had running through it a clear mountain stream, contamination being out of the question; the sanitary state of the camp and neighbourhood received special attention
We arrived in Pretoria on the 4th May and by the 14th May there were nine cases of enteric fever in hospital and two officers down with it, and this in a force of a thousand men all told. That it was enteric fever I will answer for, for I made post mortem examinations on all fatal cases with a small bush knife; and the truth of the diagnosis demonstrated by the condition of the small intestines, which were extensively attacked by the characteristic ulcerations. It was a sudden outbreak, and as suddenly ceased, but the cases were numerous enough in proportion to warrant the application of the term epidemic to it. Some positively affirm that for the production of enteric fever a specific agent must be present, and that common faecal matter may produce diarrhoea, even as a febrile character, but not enteric fever. If this be correct, whence did the specific agent come from in this case? The Traansvaal had only been inhabited by Boers for a quarter of a century, and, as far as I know, enteric fever was unknown among them. It comes to this, then either a specific germ carried with the troops from one knows not where, awaiting certain favourable circumstances for it's growth, in which case this germ would be virtually everlasting, indestructible, capable of retaining vitality under almost any and every circumstance, in air, clothes etc., capable of conveyance any distance and in any climate; or there is no special germ producing enteric fever, but producing varied forms of fever with enteric complications, which fevers can be produced without specific agents, provided certain elements are in force dependent upon, and inseparable from, campaigning in tropical zones, or under somewhat similar states when an individual goes from home to a tropical climate. We will now look at the enteric fever which accompanied the Zulu war. It must be remembered that the men forming this force (twenty five thousand strong) came out straight from England. Operations were carried on in a comparatively young country, so far as European residents were concerned, and a persistence of this fever was not ascertained. Whence did the specific germ come from in this case? The large force was divided into several columns, one at Lower Tugela, one at Helpmaaker and another at Utrecht. In all these columns, enteric fever showed itself; yet they were totally separate from one another, and the little communication between them that did exist was of the most indirect and roundabout form. Again, cases occurred at Maritzburg; men were left behind just after landing, before the poison, if it had been absorbed in the country, could have had time to develop. Others, again, were attacked after a lengthened life in tents , when they came back into the towns and took up their residence. How is this accounted for, if the specific agent theory be correct, or amenable to modern views? Rather was it not, as has been suggested by others, that 'the altered circumstances under which the men lived led to an excessive physiological action, showing itself primarily on the intestines , and overstepping the bounds of health, became pathological expending it's force in the form of a fever with the above manifestations?' The water in this case could hardly be blamed, for it was practically pure. True, the streams before reaching us had to pass through a few Kafir villages, for it follows that they must live near this commodity as well as other people; still, I venture to repeat, that they are as cleanly in their habits, and as refined in their tastes, according to their lights, as the most refined civilian of the day. Contamination, therefore, was unlikely from them, even supposing , for the sake of argument, that faecal matter could produce enteric fever. In my notes on this fever made at the time, I find my impression then was that the epidemic was caused by drinking stagnant water. Subsequent experience has led me to doubt this impression, for it is very doubtful if much stagnant water was used by the men, even if it could have produced true enteric fever
It comes to this, either the germs, if this theory is entertained, were carried from afar, or it is not necessary to have the presence of a specific poison to produce a fever, under special circumstances manifesting intestinal complications. Here was an epidemic of enteric fever with pure water and fairly good sanitation. In Egypt, we also get it with impure water, but with other conditions similar. One thing was common to both: service under canvas, with a tropical or subtropical climate , under altered conditions from those in force in the native country of the men employed. Has the water so much to answer for? Are there not other and important factors at work producing similar results, and with equally fatal force? I offer no opinion, but ask others to make their own deductions
In 1880 Karl Joseph Eberth described a bacillus that he suspected was the cause of typhoid. In 1884 pathologist Georg Theodor August Gaffky (1850–1918) confirmed Eberth's findings. The bacillus that causes typhoid fever is known as salmonella enterica enterica, serovar Typhi.
Almroth Edward Wright (also at Netley) developed an effective inactivated whole-cell typhoid vaccine that was introduced in 1896
Most developed countries saw declining rates of typhoid fever throughout the first half of the 20th century due to vaccinations and advances in public sanitation and hygiene.