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Chapter 15

Typhoid and Paratyphoid Fever;

Salmonella Infections

Physicians should look upon typhoid fever with more affection than its unsavory reputation usually evokes. A dreaded and epidemic disease for centuries, it nevertheless provided solid evidence for the germ theory of disease and proof that sickness could be transmitted by water. These two radical ideas were the work of Dr. William Budd, who recorded the story of an outbreak of typhoid fever in the small Welsh border town of Cowbridge. In 1853, during the local race week, there were balls on two successive nights; eight of those who celebrated subsequently died of "the typhoid fever." Dr. Budd noticed that the local well was close to the drains from the inn, and recorded also that a patient who was recovering from typhoid fever had left the inn two days before the parties took place. The water from the well was the only possible source of infection common to all those who died.

He reinforced his theories in 1866 when he and a colleague, Dr. Grace, traced a similar outbreak in several farm cottages. The fever was brought there by the father of one of the families. No one else was ill at the time he arrived and it was obvious that he had contracted the disease elsewhere, probably in nearby Bristol. Dr. Budd and his colleague noted that 4 weeks later several other cases of typhoid fever occurred in persons who lived in cottages which lay a quarter of a mile below the original outbreak; those who lived in cottages at a higher level escaped entirely. They found that the drains from all the cottages were linked to the same stream and that the second outbreak had occurred downstream; the "fever" was clearly carried there, contaminating the drinking water of the second group of cottages.

If all papers in the medical literature were as well written, as logical, and as simple to understand as that of Dr. William Budd ("Typhoid Fever: its nature, mode of spreading, and prevention. London, 1873"), we suspect that most of us would read our journals with much more pleasure and learn from them more easily than we do today. In many parts of the world, typhoid remains endemic, devastating, and fatal for precisely those very reasons so clearly recognized by Dr. Budd.


Typhoid fever. Enteric fever. Typhoid. Paratyphoid fever. Sp: Tifoide. Fiebre tifoidea. Fr: Typhoide. Ger: Typhoid erkrankung.


Typhoid fever is an acute febrile systemic infection caused by gram-negative bacilli of the genus Salmonella. Salmonella typhi and Salmonella paratyphi A are the most common offenders. Less often, Salmonella paratyphi B (S. schottmülleri) and Salmonella paratyphi C (S. hirschfeldii) are implicated and, more rarely, other Salmonellae and Citrobacter freundii. Other species of Salmonella cause various gastroenterocolitides with diarrhea and transient bacteremia (as discussed later in this chapter), but these should be distinguished from typhoid or enteric fever, which is a systemic infection.

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Copyright: Palmer and Reeder

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