A nurse tends to typhoid fever patients gathered in the hallway of the crowded Jose Rizal hospital in Calamba, Laguna, the Philippines, on Saturday, March 8, 2008. The Philippines' worst typhoid outbreak in a decade shows no sign of ending as authorities try to pinpoint the cause of the infection that's killed one person and sickened more than 2,000 others. Photographer: Enrique Soriano/Bloomberg NewsBLOOMBERG NEWS
If you find yourself sick with flu-like symptoms, fever and chills, abdominal pain, a rash, and severe confusion, you might have typhus. Or is it typhoid? No wonder you're feeling confused. Until the mid-1800s, doctors didn't even realize these were two different diseases, because the symptoms -- and the conditions that spawned outbreaks -- looked so similar. (You probably don't have either one, if you live in the U.S. But for the sake of argument, here's a handy guide.)
Typhus
Typhus is the unpleasant work of bacteria called Rickettsia typhi (not to be confused with rickets, which is a lack of vitamin D). Much like the bacteria that causes bubonic plague, R. typhi spreads from rodents to humans through the bites of fleas -- so if you fall ill with typhus, you have the added pleasure of knowing that it's because a flea has vomited directly into your bloodstream. Knowing is half the battle! It's easy to see why crowded living, unsanitary conditions, and poor hygiene could lead to typhus outbreaks. Typhus was especially notorious in prisons and military camps through the 19th century, earning the nicknames "gaol fever" and "camp fever."
The first symptoms of typhus usually show up within a week or two, although it might be easy to mistake them for the flu: coughing, headaches, fever and chills, aching joints and muscles, abdominal pain, and nausea. A rash starts on the torso and gradually spreads to the limbs. Eventually the infection spreads to the membranes surrounding the brain (called the meninges). The name typhus comes from a Greek word meaning "hazy," because of patients with inflamed meninges are severely confused and disoriented.
Typhoid Fever
Just to add to the haziness, typhoid fever got its name because it resembles typhus. If that's not confusing enough for you, even the bacteria responsible has a similar name: Salmonella typhi. But unlike typhus, typhoid spreads in contaminated food and water, through what epidemiologists call the "fecal-oral route." It's as gross as it sounds: S. typhi thrives in human intestines and blood, and if untreated sewage gets into the water supply or a cook doesn't wash his hands after a bathroom break, bits of feces -- laced with bacteria -- end up in food and water. That's how the infamous Typhoid Mary made so many people sick before officials forced her into quarantine.
If you ate in Typhoid Mary's kitchen, you'd get sick within one to three weeks, and the symptoms would look a lot like typhus: headaches, fever and chills, fatigue or weakness, and abdominal pain, nausea, and vomiting. But typhoid hits the digestive system especially hard, and patients end up suffering from constipation and bloody stool. Like typhus, typhoid comes with a spotty skin rash, and patients can be confused or even delirious -- although in this case, that's thanks to fever and dehydration.
Clearing The Haze
English physician Sir William Jenner (not to be confused with English physician Edward Jenner, who saved us all from smallpox by experimenting on his neighbor's son) had to examine a lot of patients, and unfortunately a lot of cadavers, to figure out the difference. Jenner was working at the London Fever Hospital in 1847 when he began to suspect that the catchall diagnosis of "continued fever" might actually be referring to different diseases, and that a more specific diagnosis could lead to better treatment. He examined 36 patients and published a book in 1850 outlining the difference between the two diseases. Of course, he passed up the opportunity to spare future students a lot of confusion by giving them clearer names!
A few years later, Jenner had the opportunity to put his expertise to the test when he was called to Windsor Castle to tend to the desperately ill Prince Albert, husband of Queen Victoria, in December 1861. Jenner diagnosed the prince consort with typhoid fever on December 9, but was unable to save him; Albert died on December 14. Two of the prince consort's cousins, King Pedro V of Portugal and his brother Prince Ferdinand, had both died of typhoid fever just a month earlier, within days of each other. (Knowing what we now know about how typhoid is spread, one must look a bit askance at the palace cooks.)
There's still some debate about Jenner's diagnosis, though. Typhoid fever usually sets in within a few weeks of exposure, and if it's not treated, patients either die or get better within a few weeks or months. But Prince Albert had suffered chronic abdominal pain since 1859, although he remained very active. Modern historians speculate that the prince consort may actually have died of Crohn's disease or cancer, rather than typhoid fever. But Jenner had made a name for himself and earned the queen's trust; in 1862, Queen Victoria had appointed him her Physician in Ordinary, making him a card-carrying member of the royal household. He took on the job of Physician in Ordinary to her son Albert Edward, Prince of Wales -- the future King Edward VII -- the following year.
And Prince Albert's fatal diagnosis must have been on his son's mind in the winter of 1871 when he, too, fell ill with a fever that Jenner identified as typhoid -- but the Prince of Wales survived the ordeal and eventually became King Edward VII in 1901. His physician, however, didn't live to see his coronation; Jenner died in December 1898. Today, incidentally, would have been his 204th birthday.
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