Typhoid Fever--It's in the Water

Disclaimer.  I am not a licensed health practitioner.  This is just another post on knowledge and understanding you might wish to acquire in advance of a disaster in case no higher care is available.  As long as our society is functioning, you should leave anything more substantial than applying a Band-Aid to the professionals.  No medication, including those available over the counter, should be taken without consulting a physician.  Information shared here is for educational and entertainment purposes only.  It is not medical advice nor a substitute for licensed medical care. 

I find history fascinating, especially as regards to how regular people lived.  I'm not so interested in how generals fought their wars, treaties diplomats negotiated, and stuff like that.  I like to understand the day-to-day lives of my ancestors.  Accordingly, family history and genealogy is a hobby I engage in regularly.  Now you are entirely uninterested in my family research, so I'm not going to go into that detail.  However, as I tell my family frequently, history repeats, and those old diseases that we are so proud to have eradicated are going to return.  Typhoid is one of those diseases.

When I research my family, I don't want to know just names, and dates, and places; I want to know about their lives.  So in the course of researching Stephen Stone and Jane Rosetta Ague Stone of Columbiana and Mahoning Counties, Ohio, I began reading microfilms of the newspapers of the 1880s-1900s.  Those old newspapers printed all kinds of valuable intel for family historians.  You not only get a picture of the daily life (if someone got a cold or an out-of-town guest came to visit, it was in the newspaper), but also of the political issues affecting them.  Obituaries weren't the super bland blather we see today; they were true portraits of that individual's life.

Scanning the newspapers for any mention of my family, I saw that one of the major issues the newspaper editors were raising was that of developing a municipal water system and getting indoor plumbing like the larger cities had.  And a major reason for that was because sooner or later people would be getting sick again, like they did every year, from typhoid fever.  And a few weeks later, the newspaper reports that there are some typhoid fever outbreaks.  And then there is a little blurb that three members of the Stone family are down with typhoid fever.  And the other newspaper reports that Mrs. Jane Stone has typhoid.  And a week or two later she was dead.

Not too many years later municipal water systems were implemented there in Ohio, but not before many more lives were lost.

Now typhoid fever isn't a concern for us; there are only a few hundred cases each year in the US, and the vast majority of those are contracted abroad by travelers visiting Africa and Southeast Asia.  But what happens when our public water systems fail?  What happens if people are again relegated to getting their water directly from rivers, streams, or shallow wells?  Yes, typhoid will rear its ugly head.

Typhoid fever, also known simply as typhoid, is a bacterial infection with Salmonella enterica that is spread through food or water contaminated with feces.  Only people can get it; animals do not and they do not transmit it (other than flies carrying it from feces to food). 

Most typhoid cases occur in poverty-stricken areas of Southeast Asia and Africa, with children being more likely to be stricken.  There were over 160,000 deaths from typhoid worldwide in 2013.  Typhoid has a 20% mortality rate untreated, or about 2% if treated.  Children under the age of four years have the highest mortality rate.  But that's today.  Historically, in this country, more men died of typhoid in the Civil War and Spanish American War than died of battle wounds.

Unfortunately, typhoid fever receives only a passing reference in all the off-grid medicine books I checked. Most of the information in this post comes from the Centers for Disease Control.

Symptoms begin six to thirty days after exposure, and the course of the disease ranges from mild to severe and fatal.  Without proper treatment, symptoms may continue for weeks to months.  

• First week:  It begins like a cold or flu.  The patient often reports a headache and sore throat.  The fever rises and falls, gradually edging higher each day (104 F).  The pulse is often quite slow in relation to the fever. There may be abdominal pain and a dry cough.  One-fourth of patients have nosebleeds.  Take the pulse and temperature every 30 minutes.  If the pulse decreases as the fever increases, typhoid is most likely the cause.  There may be vomiting, diarrhea, or constipation.
• Second week:  the patient is too fatigued to rise from bed, the high fever and slow pulse continue, and delirium may occur.  About 25% of patients develop a rose-colored rash of flat spots on the trunk of the body that fade with pressure, there may be constipation or diarrhea, and the liver and spleen become enlarged and tender.  For the first and second week, the fever rises higher in the afternoon.  
• Third week:  complications in more serious cases include intestinal hemorrhage and perforation, pneumonia, bronchitis, encephalitis, and neuropsychiatric symptoms--picking at imaginary objects on bedclothes and muttering.  
• The course of the disease may persist for weeks or months.  Unique to typhoid is the fact that about 3 percent of patients become chronic carriers like the infamous Typhoid Mary, who was responsible for at least 53 more cases and 3 deaths until she was permanently isolated.  The patient must remain in bed, resting, until the fever is completely gone. 

Definitive diagnosis is only with laboratory tests, likely to not be an option post-collapse.  None of the off-grid medicine books I have provided any treatment protocols.  Dosing regimens for ciprofloxacin and amoxicillin come from the CDC and the health department of Fiji.

The CDC indicates that azithromycin, ampicillin, and TMP-SMZ may also be used, but no dosing protocols are listed. 

	Ciprofloxacin	Amoxicillin
Adults and children 12+ years	500 mg/2x per day/5 days	75-100 mg/kg per day for 14 days
Children 8-11 years	250 mg/2x per day/5 days
Children 2-7 years	125 mg/2x per day/5 days
Children under 2 years	7.5 mg/kg/2x per day/5 days

Ciprofloxacin is the antibiotic of choice.  Amoxicillin and chloramphenicol have 5-15% relapse rates.

There are typhoid vaccines available that are usually recommended for people traveling to high-risk areas.  They're usually good for three years.

Typhoid is best prevented using good sanitation and hygiene practices, including thorough hand washing, good sanitation and latrine and waste management, as well as chlorination of drinking water.

Herbs shown to be effective in treating typhoid include Echinacea angustifolia and pomegranate peel. 

Links to related posts:
The Medicinal Uses of Pomegranate  
Echinacea--It's Most Important Uses in a TEOTWAWKI Situation 

For further reading:
https://www.health.gov.fj/wp-content/uploads/2014/05/Typhoid-Guideline_-Long-Version_-2010.pdf
https://www.cdc.gov/typhoid-fever/sources.html
https://www.cdc.gov/typhoid-fever/health-professional.html
https://www.cdc.gov/typhoid-fever/symptoms.html
https://en.wikipedia.org/wiki/Typhoid_fever