Typhoid

One of the real medical mysteries was the question of the Plague that helped cause the downfall of Classical Athens...and now, DNA analysis suggests it was typhoid...

Originially it was felt to be due to typhus or smallpox or black plague...or even a more virulent strain of measles or scarlet fever...

All these diseases have in common high fever, rash. epidemics in crowded conditions (typhus by lice, thyphoid by fecal contamination of hands and water supply) but some didn't quite fit (small pox is Pox, so the rash is different, and bubonic plague has...bubos, or large lymph nodes and is again spread by insects i.e. fleas...scarlet fever is strep throat, and many cases are mild...)...the fever often killed within a week, but if you lived, you were weak for quite awhile...and required being cared for...and often died of a second infection...or in the case of typhoid, your intestines perforated on day 21 and you died...

So how do docs figure out what disease a person has? Well, usually we try to figure out what is going around ("when you hear hoovebeats, think horses, not zebras) , what disease is similar to the pattern of the disease (what day did the rash start? Did it start on the Abdomen, like Measles, or on the wrists, like Rocky Mountain spotted fever? Is it raised or flat? etc)...

Lab testing is great, but often not positive early in a disease...and in the third world (Or in Hippocrates Athens) they may be non existant...

Typhoid's blood test is not positive for two weeks...measles requires clinical diagnosis of the typical rash...typhus, I have never treated...if Athen's fever had occured in Oklahoma, I'd worry about Rocky Mountain Spotted fever...

In the past, none of this mattered, because the "treatment" for all these diseases was good nursing and proper nutrition...the rest of the medicines did little but relieve symptoms...

But now that we have treatment, the pressure is to treat as soon as possible...so we "overuse" new antibiotics for simple disease...

But what if you have antibiotics, but no lab tests? You do your best...

When I worked in Africa thirty years ago, the joke was that if someone came in sick with a high fever of unknown origin (i.e. that we couldn't figure out where it came from after an exam) we treated them with Chloroquin (or Quinine) for malaria, and Penicillin for pneumonia...if they still had a fever after three days, we treated them with chloramphenicol for typhoid...and if they still had a fever after a week of penicillin and chloramphenicol, we did a Chest X Ray and/or sent them to the TB sanitarium....

This actually worked pretty well...one of the TB patients we shipped out later turned out to grow TB out of his bone marrow...another, from his peritoneal fluid...but then one young man popped out a lot of lymph nodes after two weeks of TB treatment...turned out he had the classic fever or Hodgkins' disease...

Oh well...back then Hodgkins was untreatable....

But it gives you an idea of how things have changed from the "good old days"...