Ep 86 Typhus: Another lousy episode

of an army. Somewhat nearer was the little fort and residence of the Superintendent Physician, and nearer still the chapel Siemen's Hospital and little village, with its wharf and a few sailboats, the most adjacent extremity being rugged rocks, among which grew beautiful fir trees at high water. This portion was detached from the main island and formed a most picturesque islet. But this scene of natural beauty was sadly deformed by the dismal display of human suffering that it presented.

Helpless creatures being carried by sailors over the rocks on their way to the hospital. Boats arriving with patients, some of whom died in their transmission from their ships. Another, and still more awful sight, was a continuous line of boats, each carrying its freight of dead to the burial ground and forming an endless funeral procession. Some had several corpses so tied up in canvas that the stiff, sharp outline

of death was easily traceable. Others had rude coffins constructed by the sailors from the boards of their berths or should I say cribs. In a few a solitary mourner attended the remains, but the majority contained no living beings save the rowers. I could not remove my eyes until boat after boat was hid by the projecting point of the island, round which they steered their bloomy way. From one ship. A boat proceeded four times during the day,

each time laden with a cargo of day. I ventured to count the number of boats that passed, but had to give up the sickening task. Oh my goodness. Yeah.

So that is from a diary that somebody published called Famine Ship Diary The Journey of a Coffin Ship, and it's written by someone named Robert White, but that's a pseudonym, and it tells the story of gross Isle, which is a place in Canada where a lot of ships sailed to from Ireland during the famine and Typhus was absolutely out of control in Ireland on the ships, and it's estimated that more than twenty thousand people died from eighteen forty seven to eighteen forty eight on these so called

Coffin ships and also in Canada when they landed. And a lot of people who died were mostly people coming from Ireland, but also like the doctors and the priests and clergymen or someone who attended attended them. So yeah, it's really by heartbreaking. God, that's awful. Erin Yeah. Hi, I'm Aaron Welsh and I'm Erin alman Updyke and this is this podcast will kill you. Welcome.

have a thinks I appreciate that. So before we begin, I just want to thank everyone who suggested topics to cover for this season, Like we got so many amazing requests, so I think that we can essentially keep doing this podcast until the end of time because literally like hundreds and hundreds of suggestions so.

to cover all of these forms of typhus. But although we're only focusing on one of these Typhus fevers, the truth is that by the end of this episode you will actually know kind of a lot about all of the different kinds of Typhus fevers, just because while these three diseases differ both in terms of their causative agents and their transmission routes and their ecology and epidemiology, they're quite different, but in terms of the actual disease or

illness that they cause, they're not all that different.

group ricketzioses. So these are very similar diseases. Endemic or murine typhus tends to be a less severe disease for the most part.

up these ricketsia. Now, then what happens is that these bacteria can infect the louse gut lining the cells that line the lice's gut their epithelial cells directly, they replicate in the gut cells of the lice, and then they burst out of those cells, which is how the bacteria gets into the feces and then is transmitted to us when we scratch that dry, flaky poop into all of our bite wounds or rub it into our eyes or nose,

et cetera. However, this whole bursting out of the epithelial cells thing also goes the other way in the louse, causing blood like our human blood that they just sucked up to enter the body cavity of the lice because the Racketzia just burst open their fragile, tiny gut. The lice that are infected then become visibly red because they're full of blood that's no longer in their guts, it's just in their body cavity, and they die within a

week of infection. I have no idea that this disease kills the vectors that it uses to maintain its life cycle.

just feeling really bad. If it's left untreated, about eighty percent of people will go on to have central nervous system involvement, which can be very severe. It can be delirium or seizures or coma, which can lead to death, and very commonly rashes are apparent. But the thing about these rashes is it's not like a single rash, you know, like with lime disease. It's like, oh, the classic bulls eye,

It's nothing like that. In some people, they'll have these like red splotchy patches interspersed with areas that if you press on them, they'll blanch, which makes they'll like you know, go to white. But then it also can either progress to or just start out as these like smaller red spots that don't blanch when you press on them, or you can have petikia, which are like pinpoint red to purple little spots all over, like teeny tiny little dots all the way up to like larger purplish splotches.

percent of people have a rash. Unsurprisingly, it's likely because, especially more recent studies that have come out of Africa, rashes in darker skin and we've talked about this a lot on this podcast are either not present, or not apparent or not appropriately identified, and so a lot of these studies, especially out of Africa, have been ones that have reported a lot lower incidents of these rashes associated

with epidemic typhus. And like even the things like whether something blanches turns back to white, like that's the definitions that we use, and that's not going to happen in the same way on darker skin as it does on lighter skin. So that's the rash, which isn't specific to

begin with, but that's generally the course of epidemic typhus. Now, overall, pre antibiotics, like before we had any kind of treatment, mortality rates were estimated to be as high as like sixty percent, which is very very high.

and malnutrition. So poor nutritional status is very strongly associated with severe infection and death compared to good nutritional status. Now, before I get into the pathophysiology, because I know you have a lot of questions. I can see them on your face. I do want to say another interesting thing about epidemic typhus, and that is that it actually leads to a chronic infection that can then be reactivated many years, like up to forty years based on one source, I

read forty years after initial infection. And this is not from re exposure, but just from reactivation of a latent infection.

So this whole chronic reactivation disease, this is called brills insert disease. It gets a whole new name, of.

They're just replicating so much that eventually they fill up our cells and literally burst them open, releasing tons of new Ricketsias to go on and infect the neighboring endothelial cell, just like in the lause aaron.

the leakage of our vessels. This is called vasculitis. So this can happen on a small scale and lead to micro hemorrhages, little tiny leaks from our tiny, little capillaries, or it can happen on a larger scale and lead to macro hemorrhages.

that process clotting cascade. But in this case, what that leads to is then these little areas of thrombus or clot in, these tiny, tiny little vessels surrounded by inflammation that then leads to cutting off of blood supply in certain areas, especially in our brain, since this is a bacteria that, by traveling through our blood vessels, is able to make its way past our blood brain barrier and infect the endothelial lining of the small vessels of our brain.

Oh oh right, so it cuts off blood flow to parts of our brain.

So antibiotics are not enough. You also have to be able to wash clothing and hot enough water to be able to kill the lice or leave the clothing and the bedding that are infested unused for at least a week so that they all die. So that's a huge part of both the treatment and prevention of epidemic typhus.

American Civil War. We've described how global movements during World War One helped spread the nineteen eighteen influenza pandemic and our very first episode, and we've even talked about the human body louse in that same war spreading trench fever, also accompanied by some very descriptive quotes of body lice and the problems with them, very descriptive. But it's taken

us this long. I still can't get over it to talk about typhus, which, as you now know, with sixty percent mortality among untreated people, it ranks among you know, plague, cholera to all of those other ones in its ability to absolutely devastate a village or a city or an entire country. The historical impact of it is huge when we think about the death toll from a war or from a famine, or even from just an epidemic alone.

I think that many of us probably imagine people dying, for example, in combat on D Day right, or in bombings from the Blitz, or maybe directly from starvation in the holodomor or directly from bubonic plague during the Black Death, because that's often how we learn about historical events. But even if that compartmentalization or like assigning deaths to this cause and that cause, even if that's a useful way

to learn, that's not really the way it happens. Alongside death in war is death in pestilence, death in famine. I mean, this is why the four horsemen of the Apocalypse, which are most often represented as pestulence, famine, war, and death. It's why they ride together, like they don't take turns, like showing up and then like okay, peace out, it's your turn now, like it's a it's a partnership.

infectious disease outweigh those from battle. And I realize, like I fully realize that right now I'm presenting a microhistory of Typhus, which is like maybe a bit hypocritical about

teaching things in isolation. So I really wanted to start off this section by saying that I hope you take away from this episode and appreciation for the enormous and horrible impact that type has had, and also to ask you to remember that while I'm talking about Typhus in Napoleon Soldiers or Typhus in concentration camps, Typhus was not acting alone. It worked side by side, aided and embedded with other infectious diseases as well as you know, human

created miseries like war and concentration camps and famine. So now that that's out of the way, I can finally get to the meat of it by first asking not where Typhus came from, but where did lice come from? Yes, where we've already talked about how fascinating we think lis are, so it was really fun to get to read more about them for this episode. And I think I might have touched on some of this from our Bartnella episode, but I'm going to go over the basics as well

as offer a self correction potential self correction. So, Rakeetzia praozekii is transmitted by the body louse, as you said, which is generally considered a different species, or at least subspecies, than the headlause. And it's been hypothesized that the body louse diverged from the head lass when a human started wearing clothing around seventy two thousand years or so, give or take, which is I think what I said also

in the Bartonella episode. But after doing more lice reading for this episode, I learned that the story might be a bit more complicated. It always is, isn't it. It always is. First of all, body lice and head lice can interbreed and produce fertile offspring under experimental conditions, which is ya. That's one way that scientists often decide whether things represent different species or not, but it's not like

the only criterion. Secondly, there are no consistent morphological differences between the two, and species or subspecies identification usually depends on like where on the body of the lice was found, So if it was not a head it's a head louse. If it's not on the body or in the clothing, it's a body louse. Under experimental conditions, researchers seem to

have been able to raise body lice from head lice. Like, they take a population of head lice and then they raise them under bodylice conditions, and you have a what looks like a body louse. Interesting. Yeah, But there are some behavioral and physiological differences between the two, namely in that the body louse has evolved to live in clothing and lays its eggs in clothing, which head lice do

not do. And there are also size differences and sometimes color differences between the two, although again those are not consistent. And until recently it was thought that body lice and head lice were indistinguishable genetically, but more recent research has led to a molecular tool that can differentiate between them. Yeah, and this finding has led to the thought that body lice and head lice aren't two different species or even subspecies.

But that they represent two different ecotypes and that's the result of a difference in the way that their genes are expressed like at some point during development or growth or I don't really know about the life stage of the life stages of the lice, but fascinating. Yeah, yeah, because I was reading that they have different like feeding patterns,

which they think leads to differences in vector competence. Why, Like body lice transmit a lot of things, and it's thought that head lice generally don't, even though they can, like you said in the lab. And also, like the ecotype thing, there's differences in their immune responses to infection with things, which then would make body lice more capable

of getting infected with bacteria than head lice. Yeah, it's really interesting and I like, probably should do some more digging on this, But I wonder if it's just like a suite of genes that are turned on in one versus the other that has like basically over time, once humans started wearing clothing, it wasn't necessarily like a one time divergence between the two, but like a continual divergence where headlice populations, especially like an over infestation, are feeding

into bodyliced populations. Like it's like, oh, I don't know what environmental cue it could be, maybe like an intense population pressure or something in a headline infestation that maybe one of them turns on those switches for the other genes. It is like, hey, I'm a body loss now I prefer a little bit cooler. I'm gonna lay my eggs out here. I'm gonna feed this way. Like it's nice

to know you guys. Fascinating Aaron. Yeah, So, like it might be semantics, whether we call them subspecies or different species or ecotypes or whatever, but I just find that whole part incredibly interesting. I do too, Yeah, yeah, Okay, So all of that nitty gritty info aside. Humans have been parasitized by lice for millions of years, and that's that's very typical of lice, Like they tend to be very species specific. They're often used to track like the

evolution of different mammalian species. Each species tends to have their own, you know, louse species. And because of this high degree of specialization, human lice have basically followed the distribution of their host, meaning that they are globally distributed, and they've been that way for a long time, and even though a lot of things are working against the preservation of lice in fossils, we do have some archaeological evidence to back this up. To back this like global

distribution up. The oldest head louse was found on a hair from eight thousand BCE in northeastern Brazil, and the oldest found in the Old World came from roughly seven thousand BCE in Israel. Combs for head lice have been found from around sixty five hundred years ago in ancient Egypt, and lice have been found on mummies in Egypt, China, the Aleutian Islands, Greenland, and parts of South America. And

I know this is like a lot about lice. So I want to read that amazing other quote that I alluded to earlier before I move on to Rikestio PRAVZAKIAI okay, so this is also from Hans Zincer. His book that rats licee in History is like a gold mine. It's a very bizarre book. I say that much. It literally was. It was like twelve chapters not about typhus or rats or lice.

human being. For the host may survive, but the ill starred louse that sticks his hostellum through an infected skin and imbibes the lowesome virus with his nourishment is doomed beyond sucker. In eight days, he sickens. In ten days he is in extremists. On the eleventh or twelfth day, his tiny body turns red with blood extravasated from his bowel, and he gives up His little ghost man is too prone to look upon all nature through egocentric eyes. To

the loose, we are the dreaded emissaries of death. He leads a relatively harmless life, the result of centuries of adaptations.

Then out of the blue, an epidemic occurs, His host sickens, and the only world he has ever known becomes pestilential and deadly, and if, as a result of circumstances not under his control, his stricken body is transferred to another host, whom he in turn infects, he does so without guile from the uncontrollable need for nourishment, with death already in his own entrails, if only for his fellowship with us in suffering, he should command a degree of sympathetic consideration.

I love it. Since that's so good. I have so many quotes in this. It's just it was. I loved that so much. And gives up his tiny ghost, his tiny ghost. Can't you picture it? I can't, Oh, his little ghost. Sorry, this gives up this. It's so cute, it's so adorable. Yeah, that book definitely did convince me to like lice more as well, like appreciate their incredible biology and right and feel a little bit sympathetic. I mean, it's killing them too. Yeah. Well, anyway, let's turn to Typhus.

Let's so, where did Typhus come from? Great question? We don't know what are you me or something? So from what I can tell, it's still debated whether Rakeetsia Praozekiah came from the Old World or the New World. For a lot of human history, the disease was grouped in with other fevers or not distinguished from typhoid, And like we said, that's a very common thing. The origin of

the words are essentially the same. Typhoid actually comes from typhus, which comes from the Greek word typhos, meaning smoky or hazy, and that's meant to describe the neurological effects that the disease can have. And I also wanted to just because

one more little thing about lice here. There are a lot of words that we use in like common English sayings that our reference to life, so like nit wit, lousy, or like a lousy night's sleep, meaning that like you were bothered by all the lice on you mm hmm,

nitpicking going over something with a fine toothed comb. And chatter, which I think we mentioned in the Barnella episode, like remember to pick chats, I think, or like to chat would be to like sit there and remove lice, and so they would call it like chatter to hang out with a group of people. And I just don't remember, honestly, Yeah, there are a lot of episodes that I'm like we did that I don't remember.

But those are pretty hand wavy, and a disease that sounds much more specific to Typhus doesn't show up in Europe until the very end of the fifteenth century, like as early as fourteen forty eight, I think, maybe fourteen ninety two in Granada, when seventeen thousand soldiers died of a disease that sounds a lot like Typhus. And then again this same similar disease shows up in the fifteen

fifties in Spain. Quote, a new disease unknown until the time of the Civil Wars in Granada appeared in Spain in the year fifteen fifty seven and depopulated the greater part of our peninsula. It did not begin to decline until the year fifteen seventy, and around the same time or a few years before, there are descriptions of what was clearly typhus in Mexico, and the disease continued to pop up in epidemic form every time there was a

drought or famine up until the nineteen hundreds. And I feel like either of those examples could be used to say, see it's clearly Old World origin, or see it's clearly New World origin. So what can the Racketzia tell us about itself? As we probably discussed in our Rocky Mountain Spotted Fever episode, the Ricketsia are these super small and bizarre bacteria. They're really closely related to mitochondria, the powerhouse of the cell, and they're very tricky to culture in

a lab. And for a long time researchers were unable to find a non human reservoir for Racketzia prooz echii. But then people began finding antibodies to the Ricketzia in some domestic animals, such as like donkeys in parts of Africa, but it wasn't always consistently found, so like that didn't seem that seemed like an incidental infection like that didn't

really seem like that was the source. But as you mentioned aarin, one place where it does seem to be more consistently found, and I'm talking about like antibody prevalence rates of forty percent or so is in Yeah, this the southern flying squirrel, which is found in like the eastern half of the US and down into parts of Mexico.

right because body lives were already globally distributed. Analysis of dental pulp our fave from remains in a mass grave in France from a siege in seventeen ten to seventeen twelve shows evidence of Rikeetzia PRAOZEKII infection, and it was also found again in dental pulp in the remains of some of Napoleon's soldiers in a mass grave in Lithuania from the eighteen twelve campaign. It's amazing what ends up in dental pulp. They also found Bartnella, which I may

have even mentioned those papers in the episode. I'm sure again I have no recollection of previous topics. But the second finding, the one of napoleon soldiers, it lends support to the idea that typhus, along with other diseases, may have been a major contributing factor to Napoleon's decision to

retreat during the Russian campaign. And I don't see how he would have had any other choice, because listen to these numbers, oh dear, of Napoleon's five hundred thousand soldiers, half a million soldiers whoa that march to Moscow in eighteen twelve, three thousand returned. Yeah. Out of five hundred thousand, three thousand returned.

this this typhoid, it's fever. Generally it was just fever fever, yeah, But it also gained some more descriptive names, such as ship fever was a common one, jail fever, camp fever, and so on to describe the typical circumstances under which epidemics occurred. Because it's important to remember that although body life were prevalent across the globe, it's not like typhus was constantly occurring. It wasn't like a childhood illness. It wasn't like, oh, you're just going to get it, and

it's it's endemic here, right. It needed a spark, which was usually provided by someone who had active typhus or who had brills in ser disease, and then it needed fuel, which was impoverished, crowded settings and malnutrition to then lead to this devastating and deadly epidemic. Even before the so called coffin ships left Ireland for North America, like in our first hand account during the Irish famine, typhus was running rampant across the country. I'm going to read another

quote quote. Never had conditions been so fatally favorable to the rapid spread of lice as in the famine winter of eighteen forty six through eighteen forty seven. The people were filthy. They had sold every stitch that would fetch the fraction of a penny, and they were wearing the same rags day after day, and night and day. Their bedding had been sold, and they slept covered with rags and old coats. To heat water or wash themselves or

their clothes with out of the question. They were eating their food half or holy raw because they had no money to buy fuel. Indeed, after months of starvation, even the strength to fetch water had disappeared. Once infection had been brought into a district, it spread with lightning rapidity

among the crowds brought together for relief. A brush in passing was enough to transfer the fever transmitting louse or its dust like excrement to a new victim, and one fever stricken person could pass on infection to one hundred others in the course of a day. A hundred. I mean, it's easy to imagine, right, Like, yeah, it's And so that quote is from Cecil Woodham Smith who was the author of the book The Great Hunger. And in this book they estimate that about ten times as many people

died of disease than of starvation during the Irish famine. Wow. Yeah, but those deaths of course probably would not have occurred, or at least in those numbers, without the lack of food or the rather the lack of access to food, because it's a complicated history, but food was still being produced and exported from Ireland during the famine. Anyway, another episode.

That's another episode. Yeah, And as you heard in our first hand those who fled or were sent away by their landlords for North America, they often met a similar fate. I highly recommend reading more about this about gross eel Canada and the typhus epidemic that occurred there in eighteen forty seven there's also a great short story called ship Fever by Andrea Barrett in a book of short stories about science. It's like, I really enjoyed it. I read

it a couple of years ago. And there's there's one like the Titular Story or whatever takes place on gross Isle, and it's so good, and we'll link to it on our website. Okay, But anyway, if you pick virtually any conflict or ecological disaster during the seventeen hundreds and eighteen hundred, you can be sure that Typhus was there. It was present during the American Civil War, although according to one paper I read, it wasn't as prevalent as you might expect.

It was in Mexico associated with drought or crop failure, it was during the Thirty Years War. I mean, like you could list tons of different instances, and it's not difficult to see why Typhus flourished so well in war and in famine, and especially in northern climates or cooler seasons. Like let's say you're one of Napoleon's soldiers, or let's say you're an impoverished emmigrant fleeing the famine in Ireland. If the way you kill lice, Like you said, it's

treatment alone is not enough. You have to kill the lice. And so if the way you kill lice is washing your clothes frequently, how do you do that when you're on a ship? You don't. How do you prevent yourself from becoming reinfested? You don't? I mean, do you are you even lucky enough to have one change of clothes? And if your soldier constantly on the move, and let's say you have a few changes of clothes, like, how

are your clothes going to dry? Do you have soap or aren't they just going to freeze in the Russian winter and then never actually dry like.

hadn't been developed yet. We have so much more knowledge and medical technology to prevent diseases like typhus today, so we'll never have to worry about it. And to a certain extent, that's true, right, Like knowing more about how it's transmitted certainly helps to prevent its spread, and being able to treat it or vaccinate against it has also

helped to reduce the mortality associated with typhus. But how does that knowledge help, or that technology help, when you lack access to medical care or even the ability to regularly wash your clothes or have multiple changes of clothes. Typhus outbreaks, like many other infectious diseases, are not just a matter of bad luck or being in the wrong place at the wrong time, or not knowing how to protect yourself from the disease. They arise and spread in circumstances,

often way beyond your control. And that's what I just kept getting from this reading about typhus, just this sense of total helplessness and horror. In these typhus outbreaks, the fever appears and there's simply nothing you can do but wait for it to get to you. Even if you know that it's an infectious disease and that it's transmitted by body lice, sometimes it's just that knowledge doesn't help you.

So when did we learn those things? Well? In nineteen oh nine, Charles Nicole published his observation that the disease was transmitted through body lice, for which he was awarded the Nobel Prize in nineteen twenty eight. Although it wasn't until nineteen thirty eight I think that people realized it wasn't the bite of the laos, but rather the feces of the laos that transmits the pathogen and the causative

agent of typhus. Rickettsie PRAWOZAKII was discovered really by several people, but it was named in nineteen sixteen by Enriq de Rochalima, a Brazilian doctor whose colleague Stanislas von Prowsek died of typhus while investigating it, just like Howard Ricketts, who also died of typhus. If you remember back to our Viking

spotted fevers. Yeah, do you remember that? Yeah? And Ricketts died while investigating typhus in Mexico in nineteen ten, and so de Roshalima named the bacterium to honor these two researchers who lost their lives while studying the thing that killed them, which is sad.

New York's Lower East Side. It was a mild disease that he described, which is why he didn't consider it to be typhus initially, and it seemed especially prevalent among older people mourning the loss of a spouse, so he actually called it bereavement disease. Oh, fascinating, Yeah, which I can imagine that being a hugely stressful and traumatic experience.

That way exactly what I was going to say, we activate, Yeah, but later it was shown by Hans Sincer to actually be this reactivated form, and so hence real Sincer fascinating. But again, even with all of this new knowledge being gained about the disease and the bacterium, it continued to cause devastating epidemics during World War One. In many countries in Eastern Europe, such as Poland, it turned endemic to

epidemic among both civilians as well as soldiers. In Serbia in nineteen fourteen, after the Austrian invasion, Typhus broke out and caused a massive epidemic with an estimated five hundred thousand cases, of which one hundred and twenty thousand were fatal. Oh my goodness. During this epidemic, more than half of the physicians in Serbia died or were incapacitated by typhus whoa Overall during World War One, it was estimated to

have infected between twenty and thirty million people. And once the war was over, it's not like Typhus just went away. Russia especially was in a great deal of turmoil and unrest with the Russian Revolution beginning in nineteen seventeen even before World War One ended, so there was like just

chaos and yeah, and typhus took advantage of that. Between the years nineteen seventeen and nineteen twenty one, it's estimated that around twenty five million people in Russia became infected with typhus and two and a half to three million died. Like those numbers are they surprised me because it was

just I didn't realize, Like I just didn't realize. And it was this huge epidemic in Russia, along with the enormous number of typhus infections during World War One, that inspired many people to start working on typhus vaccine, and several countries had entire research organizations devoted to this, which shows just how terrified of the disease that people were, and you know, rightly so. So. One of the most prominent of these typhus researchers in the years after World

War One was a man named doctor Rudolph Weigel. Doctor Weigel was born in what is now the Czech Republic and lived most of his life in Levoff, which was then part of Poland now it's part of Ukraine. At his lab in Levoff, he made great strides with developing a vaccine for typhus that didn't entirely prevent the disease, but it did make it much less deadly if you contracted it. But he faced a problem that was common

to anyone researching typhus or other ricketzial diseases. Rickettier were notoriously difficult to maintain in culture and lab settings, and it was also hard to get enough material to make the vaccine. Like the manufacturing side of it was hard. Mice in guinea pigs didn't really seem to become infected with rakeetsie prawozek yi, so they weren't a great solution. So, faced with this challenge, Wygel came up with another solution.

Use the louse as the maintenance animal. Grind up infected lice and then inject that into the butts, like through the butts of uninfected lice to infect them to then you get more infected lice, you get to make more vaccine. Yeah, which, like that seemed to work actually through.

But essentially, you strapped little boxes containing lice to your legs or arms and allow the lice inside those boxes to feed for a set amount of time okay, And if you happen to be one of those lucky louse feeders, you would be feeding up to thirty thousand lice at a time apparently, which would produce enough vaccine material for three hundred people in one week. Wow. Okay, that's pretty good.

I feel like it's a pretty noble job. It was also decent paying, and I would say relatively safe, okay, because if you had never had typhus before, you were only allowed to feed the uninfected lice okay, And if you had had typhus then you could earn a bit more money by feeding the lice that were infected. But it did lead to some unfortunate side effects. Like blood loss and you know, allergic reactions on occasion. But still, by the nineteen thirties, Weigel's lab had become the world's

typhus lab. People came from all over to study his louse colony and to learn how to make the Weigel vaccine. Basically, he would put as many as fifty lice into what was called the Weigel clamp, where their little life butts would were perfectly positioned for being injected with a slurry of their infected dead friends. Oh my gosh. And then those infected lice fed on more human blood, and then

they were dissected. They're intestines removed and then homogenized, then centrifuged, then diluted with saline and phenol which would kill the bacteria, and then boom, there's your vaccine. Wow, it's basically just like you know, mushed up Laus intestines.

in academia. In nineteen thirty seven, for instance, a law was passed that Jewish people had to remain standing in university classes in Levolf, and Weigel, for his part, rejected these policies, for example by saying, well, I'm not going to sit down until they can sit down, which is something that many of his colleagues were either too afraid

or too prejudice to do. But war was inevitable and German forces invaded Poland on September one, nineteen thirty nine, followed by Soviet troops, and Poland was partitioned between the two. During first the Soviet occupation and then the Nazi occupation of Levolf, Weigel was forced to keep working at his institute producing Typhus vaccine when so many other Polish intellectuals were being deported or imprisoned or just outright killed by

both Soviet and Nazi troops. Why were Weigel and his labs still there, not just allowed to work, but like forced to work. Well, it's because Typhus was a terrifying threat, and so Weigel's work was viewed as invaluable and under German occupation, Weigel's institute grew rapidly, where it served as often the only means of survival from many Polish people

who faced death, starvation, or deportation. Weigel went out of his way to hire hundreds of people as Laus feeders, often Polish intellectuals or Jewish people, people who were under incredible threat from Nazi occupation. And it's not certain exactly how many Polish people ended up working at the institute as Laus feeder, but it's been estimated between twelve hundred and three thousand, wow, which is a lot.

excuse me, like that's that's a bit extreme. But but yeah, so other people did the you know, the I don't know if we can call them clinical trials, but yeah, he he did seem genuinely concerned. Yeah, and it is one of the rare instances. However, don't speak too soon, because there will be I've been waiting for it. Oh yeah, yeah,

the other shoe will drop. Yeah. Yeah. So all of these people like this was their lifeline, right working as the louse feeders, and while feeding the lice, people often sat around and chatted, exchanging ideas about philosophy or mathematics or I read one description of a conversation about why salt is used to make ice cream, but it's also used to melt roads, like melt ice on roads, So

how does that work? And there are some great pictures of the louse feeding and some of these common areas where people are just sitting around with louse cages on their bodies. I'll try to post those. But the conversation during the louse feeding it wasn't always about like, you know, philosophy or even trivial things. About half of the feeders were actively working in the resistance, and the louse feeding

was a great cover right. It allowed them to get out of the house and also to have free time for underground activities. And the institute wasn't just a place for resistance talk but also resistance action. Workers would sabotage the Typhus vaccines intended for German soldiers, making them much less potent, while tens of thousands of full strength doses were smuggled out of the lab and into the Jewish ghettos,

where licee infestation was incredibly high. Oh my goodness. Yeah, and just to illustrate again, because I think it's difficult to imagine how extreme infestation could be. So this is a quote from Henrik Spilman. I know that I mess up that pronunciation, and I'm sorry, describing lice in the Warsaw ghetto in his memory the pianist the lice quote crawled over the pavements, upstairways, and dropped from the ceilings of the public offices. Lys found their way into the

folds of your newspaper, your small change. There were even lice on the crust of the bread you had just bought. And each of these verminous creatures could carry typhus. The black market vaccines from Weigel's lab did help save thousands of Jewish people from a death due to typhus, but few of these people survived the concentration camps that they

were ultimately sent off to. So I don't think that I've adequately described yet just how terrified the Nazis were of typhus and how they used this fear as an excuse to enact horrific policies. Because Typhus wasn't seen as this universal threat from like oh this you know, bacteria or this louse, anyone could be impacted, it was of

course blamed on Jewish people. Nazis used Typhus as part of the justification for the construction of Jewish ghettos, and public health orders for bathing and delousing often had this undertone of anti Semitism, like beards were ordered to be shaved, for instance, and just to note that there are no new evil ideas under the sun. This was not the first time that an ethnic group was blamed for the spread of typhus, and that Typhus was used as an

excuse for genocide and murder. For instance, during World War One, there had been brutal medicalized torture carried out on prisoners of war or political prisoners, and also just like straight up genocide, like when nearly fifty thousand Armenian refugees were

placed into concentration camps and most were murdered. With typhus often used as an excuse and upon entry into the Nazi concentration camps during World War II, people had to undergo disinfection and quarantine because the Nazi soldiers were incredibly scared of the disease spreading to them, hence the stripping

and shaving and chemical baths. A single lause was sometimes used as an excuse to torture hundreds of people, but these quote sanitation efforts did next to nothing to stop the spread of the disease among those imprisoned in the

concentration camps and prisoner of war camps. To illustrate, by November nineteen forty one, the German Army had captured one and a half million living Soviet prisoners of war and placed them in labor camps across Europe, where fifteen thousand died of typhus each day, yeah with additional deaths due to starvation and cold and likely other infectious diseases, and this massive increase in typhus prevalence put Germany in a typhus panic by nineteen forty two, and they looked beyond

vaccines for help to prevent the spread. Zyklon B was developed as a disinfectant for lice as like a delousing agent, and it was found to be extremely successful in killing the lice, but it was also found to be extremely

toxic to humans. Of course, this toxic side effect was included in the report of the chemical like for like, the final analysis of like this is you know where we stand in its development, and Heinrich Himmler happened to read this report and he was like, wait a second, I know where we can use this, and so it gave him the idea to use it in gas chambers

in concentration camps. Like the fact that it was deadly to humans, and so zyklon b gas, which was originally developed as a delousing agent to prevent the spread of typhus, was used to mass murder millions of people at Auschwitz and at many other concentration camps. I know, I'm sorry, this is like a super difficult and sad and frustrating history to hear, but I think it's important to learn and remember.

the story. Despite all of these, like I said, sanitation efforts, despite all of this fear surrounding the spread of typhus in concentration camps, the disease continued to spread there, like throughout the entire war. And I learned in researching this episode something I didn't know, which was that Anne Frank likely died in a typhus epidemic that killed seventeen thousand people at bergen Belsen in the last months of World

War Two. I just I didn't you know, like you don't again, like you said, we learned about these diseases an abstract Oh, typhus killed this many people, and typhoid killed this many, and dysentery killed this many, but like it's yeah, yeah, placing it in the context. So there are no good estimates that I could find for the total number of people who died of typhus and concentration camps or prisoner of war camps during World War two, but I'm sure that it's a staggering number, all right.

So now for a last, maybe slightly less depressing bit of World War II history. There was a Polish physician and biologist named Ludwig Fleck who worked alongside Weigel in his laboratory during the nineteen twenties, and like Weigel, he

worked on typhus vaccines and typhus biology. But unlike Weigel, Fleck was Jewish and so was eventually excluded from academia entirely, just prohibited from working there, and so he started a private lab and he remained connected to the academic community as much as possible, and in many ways he was like way ahead of his time. Than his peers in terms of like the use of statistics in his research,

and also in his philosophical approach to science. He was interested in the sociology of science, in the way that people thought about scientific questions, the philosophical matter of what is sickness and what is health like where does that line? And he felt very strongly that advancements in science and medicine were not made by one person, but by a community working together, a concept that would inspire Thomas Kuhn when writing his Structure of Scientific Revolutions a couple decades later.

And Fleck was also concerned with the growing division between science and the humanities, and with the fact that as scientific knowledge grew, it became more inaccessible to non scientists. So I think we can really appreciate as a science podcast, we can really appreciate that last part in particular. But as a Jewish researcher in Nazi occupied Poland, he was

not free to express any of these thoughts. Really, And this is a very condensed version of Fleck's story, And if you want to read more, I will recommend a book called Doctor Weigel's Fantastic Laboratory. But anyway, during the occupation. He was commandeered by SS doctors who first had him work at a Jewish hospital where he began working on a typhus vaccine to try to give to the Jewish patients that he treated, and to also smuggle it out

to the ghettos as well. But unfortunately, the Nazis grew suspicious that he was trying to help people, and so they sent him and his family to first Auschwitz and then Buchenwald. Not as prisoners per se, I mean, although they were prisoners in everything but name right, like couldn't move freely or yeah, they always had the threat of death hanging over them. But he was sent there to

conduct research on typhus, specifically vaccine. Horrifying medicalized torture plans were drawn up initially by the SS doctors in charge, of course, and there was medicalized torture carried out during World War Two, absolutely, but thankfully those specific plans were not something that Fleck had to carry out. Rather, he was tasked with making a vaccine for typhus to administer to Nazi soldiers, and he did, he was asked, But this vaccine was a vaccine in name only. It wasn't

real It didn't do anything. Yeah, he and some of his colleagues who were in the know, were making a fake vaccine that was just absolutely nothing that they sent out to the German troops while at the same time making a real vaccine that they administered to the people who were imprisoned in the camps. Wow. And they kept up the charade when anyone suspected them of not sending a real vaccine, like people will come back and be like, hey,

people are still getting sick. This vaccine isn't working. And so then they had like a little vial of real vaccine on the ready to be like, no, here it is, go ahead, test it, do what you want with it. And they they did this. So I just I love, like, I don't know, I really liked reading about that, that act of resistance. And they kept this up for like,

you know, quite a bit of time. And the truth about this vaccine sabotage came out in the Nuremberg trials for the Nazi doctors, and when they learned about it, they were shocked and outraged. They were like, you haven't shown any humanity, How could you do that to us? And like literally when they said that people in the courtroom just laughed. They were like this, you haven't shown humanity because you gave fake, fake vaccine to people who

were literally carrying out genocide. Okay, oh wow, Okay. So going back to I feel like what has become the theme of the history section. In World War Two? People knew what the causative agent of typhus was, they knew how it was transmitted, they could test for it, they could

vaccinate against it. Even but yet it's still infected and killed an untold number of people, people from whom treatment or vaccines were withheld intentionally, people who were forced to live in conditions that were absolutely perfect for the spread of typhus. Outside of the concentration camps, typhus wasn't nearly as prevalent as it had been during the First World War.

Most American troops, for example, were protected by the vaccine developed by Harold Cox at the Rocky Mountain Biological Labs in Hamilton, Montana, and shortly after the war, chloromphenacol and other antibiotics were found to be effective against typhus, which did help bring down like the mortality rate, but again, typhus lingers like it still lingers. It infected and killed many people in the gulag in the Soviet Union, for instance, And it often pops up when large groups of people

are displaced due to conflict or ecological crisis. So I think I have three take home points from this, at least three. I mean, probably more that I'll realize, but whatever. Number one, Typhus is much more devastating and has had much more of an impact than I realized before doing this episode, like I wow. Yeah. And number two it just reinforces again the idea that medical technology and knowledge

alone doesn't prevent disease. And three that Typhus may seem like a disease of the past, like a disease of just in the history books, but it's still here and it's unlikely to go away forever. It can and has popped up in these times of conflict, of food shortages or ecological disasters, and more of those are on the horizon. Yeah, and I don't really get the sense that we're prepared for that. So, Aaron, what's going on in the world of Typhus today? How is that segue? Oh gosh, Sharon.

outbreaks under certain circumstances. So in nineteen ninety seven, there was an outbreak, largely in Burundi that caused an estimated over one hundred thousand cases.

get at the epidemiology of these Typhus group ricketsioses. So one of them was looking at these Typhus rickettsioses in China from twenty five to twenty seventeen, and that paper determined that there was a total of twenty nine thousand cases reported in that twelve year period. But it didn't distinguish between epidemic typhus and what they called endemic or

this fleaborn or murine typhus. But it noted that based on the epidemiologic patterns, most of these cases fit the seasonal distribution and the kind of ecological distribution of endemic typhus not epidemic typhus. Okay, So that doesn't give us a lot of information about what we're focusing on for this episode, but suggests that the majority of typhus ricketsioses in China from twenty five to twenty seventeen was not epidemic typhus, so very low numbers, if any.

other ricketziosis. So that's quite different. Yeah. Another study that was looking at febrile illness in kids in Kenya, so this is just in children, and this is just sort of like a cohort study. This is from twenty eleven to twenty twelve, they found that one and a half percent of kids that came in with a fever tested positive for typhus group ricketsiosis. But again, this doesn't distinguish between epidemic and mirroring or endemic typhus.

So in a lot of parts of the world, we don't have great diagnostic We're not getting down to that nitty gritty.

people are found to be suffering from body lice. And what all of these situations have in common, of course, is things like crowding and poor sanitation, which lead to very efficient person to person transmission of body lice and persistence and transmission of these lice on clothing. So I think there's a lot of things that contribute to epidemic typhus, especially although I want to point out that scrub typhus.

One paper that I read suggested that it's possibly the single most neglected disease, like oh, of all time, I mean, oh, very interesting.

being relatively understudied. Definitely, I would assume, though I don't have numbers on it, underfunded compared to a lot of other diseases today, despite it being such a massive problem historically, is because I think it's very easy to ignore the most vulnerable populations, who are the ones that are most likely to be affected by epidemic typhus in the case of an outbreak, right right, And it is in fact these most vulnerable populations forcibly displaced migrants, of which there

are an increasing number year after year. And we talked in our dysentery episode about how many hundreds of millions of people live without access to sanitation and clean water facilities. If you don't have access to that, how are you going to keep lice off of your clothing?

But part of me wonders whether we're in this little in this nice little dip in the history of typhus right like right now, it declined rapidly and there's not really much going on, but it's really hard to see any way that it would stay at such little levels.

And then also that collection of short stories called Ship Fever by Andrea Barrett, The Great Hunger Ireland eighteen forty five to eighteen forty nine by Cecil Woodham Smith and the first hand account came from the Ocean Plague by Robert White. And then of course I have to mention one of the most classic books in disease history or the history of disease, even though it kind of doesn't really it's not a great history of diseased book, but

it's an interesting book anyway. It's called rats Lice in History by Hans Zencer and I have a ton of papers. I'm going to put them all on the website, so you know, please take your pick of them.