Speaker 1: Number one, The camp at Chickamauga was a perfect hell
Speaker 1: on earth. War itself would have been a paradise compared
Speaker 1: with the peace of this camp. I saw many awful
Speaker 1: sites there, men dying under the trees for the want
Speaker 1: of a glass of water. I found there men who
Speaker 1: had been sick with typhoid fever for days, and who
Speaker 1: had not received medical attendants. No one had even taken
Speaker 1: their temperature. It was awful for five hundred men in
Speaker 1: hospitals there were only a dozen attendants. The water from
Speaker 1: the creek was simply mud, and yet the boys had
Speaker 1: to bathe in it and drink it. Everything about the
Speaker 1: camp was badly managed. As for the food, there is
Speaker 1: only one way to describe it.
Speaker 2: It was rotten. Number two.
Speaker 1: Someone is to blame for keeping an army of forty
Speaker 1: five thousand men at a camp where all the water
Speaker 1: was unfit for a dog to drink, where there was
Speaker 1: no drainage, no proper food or medicine, and where the
Speaker 1: conditions were so unhealthy that every man of forty five
Speaker 1: thousand and had intestinal troubles. Three fourths of the army
Speaker 1: slept in little dog tents, as we called them. They
Speaker 1: were five feet long and four feet high. There were
Speaker 1: no cots. The men slept on the ground, and it
Speaker 1: rained nearly all the time for six weeks. Our division
Speaker 1: hospital was arranged to hold two hundred men, but we
Speaker 1: had over five hundred sick men in it. Each tent
Speaker 1: was arranged to hold six men, but we had ten
Speaker 1: and twelve crowded in. There were not cots enough, and
Speaker 1: sick men had to lie on litters on the wet ground,
Speaker 1: sometimes for a week. The sick came in fifty and
Speaker 1: seventy five at a time, and there were no cots,
Speaker 1: no medicines, no food for them except the irregular army
Speaker 1: rations issued to well men. The men detailed for nurses
Speaker 1: were the poorest soldiers in the camp. They nursed the
Speaker 1: sick eight hours in the day and then worked three
Speaker 1: hours digging sinks and trenches and cleaning up the camps.
Speaker 1: Number three, in the camp of the third United States
Speaker 1: Volunteer Cavalry, we found the sinks fold to the top
Speaker 1: with fecal matter. Soiled paper was scattered around the sinks,
Speaker 1: and the woods behind the regimental camp was strewn with
Speaker 1: fecal matter. The second Kentucky Volunteer Infantry was located in
Speaker 1: the woods. Fecal matter was deposited around trees, and flies
Speaker 1: swarmed over these deposits, not more than one hundred and
Speaker 1: fifty feet from the company mess tents. The odor in
Speaker 1: the woods just outside of the regimental lines was vile. Yeah, yeah,
Speaker 1: why why are they poop and InSync?
Speaker 2: Like there was nowhere else to poop? Okay, dig a
Speaker 2: hole what I mean?
Speaker 1: So, but all the holes got filled either with poop
Speaker 1: or with water, and then the rain water would make
Speaker 1: the pop rise to the surface and spread around.
Speaker 3: That's atrocious. Yeah.
Speaker 1: So that was from the report of the Commission appointed
Speaker 1: by the President to investigate the conduct of the War
Speaker 1: Department in the War with Spain, essentially the Spanish American
Speaker 1: Wars reports from that around nineteen hundred is one of
Speaker 1: these reports were all made, Yeah, a few different excerpts.
Speaker 1: I thought it was more fun to do a little
Speaker 1: smattering of harries essentially.
Speaker 2: Yes, and you'll.
Speaker 1: Hear why I picked the Spanish American War for the
Speaker 1: subject of today's episode later on.
Speaker 2: But first, Hi, I'm Aaron Welsh.
Speaker 3: And I'm Aaron Olman Updyke.
Speaker 1: And this is this podcast will kill You.
Speaker 3: And we're back with season four.
Speaker 1: We are back, and I'm very excited.
Speaker 2: I think we definitely needed.
Speaker 3: That break, oh big time.
Speaker 1: Yeah, so we appreciate you guys for being patient and
Speaker 1: sticking with us, Yes and yeah, letting us get a
Speaker 1: little bit of a time to take a breather and yeah.
Speaker 3: Well and also get a bunch of fun new episodes
Speaker 3: lined up for.
Speaker 2: Oh so many fun new episodes.
Speaker 3: Yeah.
Speaker 1: Yeah, speaking of fun new episodes, what is the topic
Speaker 1: of today's episode?
Speaker 2: Maybe our break was too long?
Speaker 3: Eric, No, No, I actually love that. I feel like
Speaker 3: most of the time lately, our first hands completely give
Speaker 3: it away, and now it's like Spence has been building
Speaker 3: for like.
Speaker 2: Two whole minutes. Yeah.
Speaker 1: Well, I guess if no one clicked on the title
Speaker 1: of the episode, maybe there's an auto played.
Speaker 3: But today we're talking about typhoid fever.
Speaker 2: Oh, typhoid fever.
Speaker 3: This one has been a long time coming, Oh, very
Speaker 3: long time coming.
Speaker 1: I am super excited to cover this one because typhoid
Speaker 1: fever was sort of the episode. I feel like that
Speaker 1: really changed our lives.
Speaker 3: Yes, it changed our lives one thousand percent, even though
Speaker 3: we have not yet covered it. Yeah, because typhoid the
Speaker 3: story of typhoid Mary is the story that Georgia Hartstark
Speaker 3: told when she first gave us a shout out on
Speaker 3: My Favorite Murder, which is like what led to like
Speaker 3: our lives changing forever.
Speaker 1: All the way back, in case you're interested in listening
Speaker 1: all the way back in episode one oh five titled
Speaker 1: per I looked it up and I listened to it again.
Speaker 2: It's for research for this episode.
Speaker 1: Yeah, yeah, this is definitely like a full circle moment.
Speaker 3: We've been waiting for this episode since like twenty eighteen eighteen, yeah, eighteen.
Speaker 1: Yeah, I'm just so excited for it.
Speaker 3: Me too.
Speaker 1: But before we get into the actual meat of the episode,
Speaker 1: we do have some pieces of business, starting.
Speaker 3: With quarantin any time.
Speaker 1: Quarantine any time, Aaron, What are we drinking this week?
Speaker 3: Of course, we could be drinking nothing other than a
Speaker 3: bloody Mary, bloody typhoid Mary, bloody typhoid Mary. Not just
Speaker 3: any bloody Mary, not just any.
Speaker 1: This one is titled differently, but yeah, other than the title,
Speaker 1: it is essentially a bloody Mary who doesn't love the
Speaker 1: bloody Mary. You can pick and choose whatever pickled vegetables
Speaker 1: you want to put in there. It's tomato juice, it's
Speaker 1: cu it's you know, worcessre sauce, it's hot sauce. It's
Speaker 1: whatever you want to put in there.
Speaker 3: It's how you like a bloody Mary?
Speaker 1: Yeah, an entire like hamburger on a on a stick. Yeah,
Speaker 1: anything you want to put in there. We will post
Speaker 1: the recipe to the bloody typhoid Mary as well as
Speaker 1: the non alcoholic plac Brita on our website this podcast
Speaker 1: will Kill You dot com, as well as on all
Speaker 1: of our social media channels.
Speaker 3: What other business do we have to attend to, Aaron.
Speaker 1: Well, let's see, let's go over the usual suspects. I mean,
Speaker 1: number one, we've got merch. We've got some super cute
Speaker 1: new things that.
Speaker 3: Are very exciting things.
Speaker 1: In fact, the amazing artist Holly Sullivan did some new
Speaker 1: designs for us, including and you can get prints of
Speaker 1: her designs right now, and stickers of your Cinea pestis
Speaker 1: eighties a jip dye of the influenza virus of Giardia.
Speaker 3: However you like to say it.
Speaker 1: And then there's also other really cool things like one
Speaker 1: of my favorites is the Quarantining Time T shirt. It
Speaker 1: is so soft and I also have to admit of
Speaker 1: to always wearing the hoodie around.
Speaker 2: It's like the perfect weight.
Speaker 1: And then I drink out of the pint glasses and
Speaker 1: the socks are just too cute.
Speaker 2: I can't handle it.
Speaker 3: We also heard you, guys when you asked for face masks,
Speaker 3: since those are now pretty much a staple of everyone's wardrobe,
Speaker 3: so we have two different face masks, including one that
Speaker 3: says wash your hands. You have filthy animals.
Speaker 2: They both do.
Speaker 3: Oh, they both do.
Speaker 1: They are super cute. I really I love them all.
Speaker 1: So yeah, go check it out. You can get to
Speaker 1: it by the This podcast will Kill You dot com website, click.
Speaker 2: On the merch tab. Yeah great, let's see. Okay, more business.
Speaker 1: We can run through the rest of the usual suspects,
Speaker 1: which includes hey, check it out. We've got a bookshop
Speaker 1: affiliate account, so if you're interested in doing any additional
Speaker 1: reading on any of the topics that we cover, we
Speaker 1: link to the books there also through our website, and
Speaker 1: we also have a good Reads list, so check it
Speaker 1: out too. Other people can add suggestions there, so you
Speaker 1: get like a whole smattering of both fiction and nonfiction
Speaker 1: disease readings.
Speaker 3: It's pretty cool, and if you would like alcohol free versions,
Speaker 3: of these episodes. Maybe you're a teacher, you want to
Speaker 3: use these for whatever reason, Maybe you just don't want
Speaker 3: to hear us talk about quarantinies. You can find those
Speaker 3: as well on our website, this podcast will Kill You
Speaker 3: dot Com.
Speaker 2: And then we have a couple of new announcements.
Speaker 1: So the first is that we are going to be
Speaker 1: picking up again our Anatomy of a Pandemic series, which
Speaker 1: covers the COVID nineteen pandemic. So we stopped releasing episodes
Speaker 1: in May, and now we are going to take some
Speaker 1: time to revisit some of these topics. You know, what
Speaker 1: have we learned so far about the virus. Everyone wants
Speaker 1: to know about the vaccine and where we stand with that,
Speaker 1: and so we are going to be putting those out
Speaker 1: as we work through these normal episodes. So don't worry,
Speaker 1: the normal episodes won't be interrupted. Yeah, and we also
Speaker 1: still have the first the COVID nineteen first hand account
Speaker 1: submission form still active, So if you would like to
Speaker 1: share your story potentially as a first hand account in
Speaker 1: one of these episodes, please head to this podcast We'll
Speaker 1: Kill You dot com and click on the COVID nineteen
Speaker 1: first hand tab at the top of the page.
Speaker 3: Is that all the things?
Speaker 2: I think that's it. I'm exhausted.
Speaker 1: All right, let's circle back around tomorrow to pick up
Speaker 1: the actual episode.
Speaker 3: A perfect good idea, good idea.
Speaker 2: Ah, but I guess yeah.
Speaker 1: Can we finally start talking about typhoid?
Speaker 4: Yes?
Speaker 3: I think we are ready. We'll take a quick break first. Great.
Speaker 3: I think this is one of the most classic and
Speaker 3: also most specific diseases that we've done in a very
Speaker 3: long time.
Speaker 1: You mean, like it's not super complicated where it has
Speaker 1: all these different norms and this and that.
Speaker 3: No, No, it's plenty complicated.
Speaker 1: Oh good, Okay, but it is a very classic TPWKY feel,
Speaker 1: which is kind of fun and why we chose to
Speaker 1: do it for our fourth season premiere exactly.
Speaker 3: It's a very classic feel. But then it's also well,
Speaker 3: I'll get into it and you'll see what I mean
Speaker 3: by specific. Okay, okay, okay. So, typhoid fever, which is
Speaker 3: also called enteric fever depending on where you live, is
Speaker 3: the disease that is caused by a gram negative rod
Speaker 3: shaped bacteria whose full name is Are you ready for this?
Speaker 3: I know you know this already, but I.
Speaker 2: Know it's a big one. It's a mouthful.
Speaker 3: Salmonilla enterica subspecies Enterica serah var typhe. And that's what
Speaker 3: I mean by specific.
Speaker 1: I don't quite understand why why Okay, this is a
Speaker 1: sarah var. Great, really great question. I'm so glad that
Speaker 1: you asked it, Darren.
Speaker 2: You know I was going to yes.
Speaker 3: So first of all, we're just gonna call it by
Speaker 3: its shorthand name, Salmonella typhee. Okay, that's how you can
Speaker 3: refer to it. Now, there are something like twenty five
Speaker 3: hundred different serovars of salmonilla, salmonilla and terica even and
Speaker 3: at least fifty of them are pathogenic, although not all
Speaker 3: of those are pathogenic to humans. So you asked, how,
Speaker 3: like what makes the serovar? You can kind of think
Speaker 3: of it like, you know how we name influenza strains
Speaker 3: by their H and their N yep. Okay, So serovars
Speaker 3: are differentiated by from each other by those specific antigens
Speaker 3: on their surface. So in the case of Salmonella, it's
Speaker 3: their lipopolysaccharide, which is an O antigen, and their flagella
Speaker 3: flagellar antigen, which is an H antigen. So that's how
Speaker 3: we identify them. You'd like to know the serovar name
Speaker 3: of salmonilla serovar type, it's O nine to twelve v
Speaker 3: IHD dash. That's an easy thing to remember, right, Yeah, Okay,
Speaker 3: So I'm going to start off with a side note.
Speaker 3: There's another serovar, a couple of other seravars actually that
Speaker 3: are called para typhee. So there's paratype A, B, and C.
Speaker 3: This serahvar causes a very similar but generally more mild illness,
Speaker 3: and so the term enteric fever usually encompasses both the
Speaker 3: diseases caused by salmonilla typhee and salmonilla paratyphee. So we're
Speaker 3: going to try and stay as specific as possible in
Speaker 3: this episode and really just focus in on salmonilla typhe
Speaker 3: or typhoid fever.
Speaker 2: Cool, gotcha Cool.
Speaker 3: So Salmonella typhe is what is referred to as a
Speaker 3: host restricted pathogen, so it primarily infects just humans and
Speaker 3: then also like chimpanzees. All right, so how is it transmitted?
Speaker 3: I know, you know, and everyone that listened to the
Speaker 3: first hand probably has a guess.
Speaker 1: I mean, if you're playing bingo with the number of
Speaker 1: times that fecal is going to be said in this episode.
Speaker 3: With a lot. Yeah, fecal oral so poop in mouth
Speaker 3: wherever poop can end up then ends up in your mouth,
Speaker 3: you can get infected. Okay. One thing that's important, and
Speaker 3: I think this is actually really interesting considering that this
Speaker 3: is a fecal oral transmitted parasite, is that Salemonella is
Speaker 3: actually really acid labile, so it does not tolerate the
Speaker 3: environment of your stomach very well at all. So that
Speaker 3: means that the infectious dose is really really high compared
Speaker 3: to a lot of other bacteria and viruses that we've
Speaker 3: talked about on this podcast.
Speaker 2: Interesting, like r how high.
Speaker 3: At least ten thousand bacteria to cause an infection and
Speaker 3: even at that number, the attack rate, so the percentage
Speaker 3: of people who would actually get like sick is low,
Speaker 3: like ten to twenty percent at that infectious dose.
Speaker 1: Okay, how much bacteria is an infected person or a carrier?
Speaker 2: Shetting?
Speaker 3: Such a good question. I don't even know if I
Speaker 3: know the answer to that. Let me scroll through my
Speaker 3: notes in an average poop in an average poop, that's
Speaker 3: a good Aaron, what a good question that I don't
Speaker 3: have the answer to in all of my notes.
Speaker 1: Just FYI, guys, we just spent a little bit of
Speaker 1: time both looking for the answer. I mean, like not
Speaker 1: that long, but you.
Speaker 3: Know, more than a few minutes.
Speaker 1: We spent more than a few minutes, and we couldn't
Speaker 1: find anything, and so we just think it's safe to
Speaker 1: assume that it's.
Speaker 2: It's probably a lot.
Speaker 1: It's not going to be like there's been a lot
Speaker 1: of typhoid fever epidemics and it's.
Speaker 3: Got to be a lot because it takes a lot
Speaker 3: to get you sick, and you poop a lot when
Speaker 3: you have typhoid fever, so uh, you know, and it's
Speaker 3: a it's a Salmonella bacteria which reproduced very quickly, so
Speaker 3: a lot a lot.
Speaker 1: Hey, if somebody can find the actual number, that would
Speaker 1: be that would be super cool.
Speaker 3: Love would love that actual number. But what I did
Speaker 3: want to say about this is that what's really interesting
Speaker 3: saying is that the smaller the infectious dose, the longer
Speaker 3: the incubation period, So the longer between when you first
Speaker 3: get exposed to when you start to show symptoms, which
Speaker 3: is logical, but it's nice when we can see that
Speaker 3: in data. Cool. Okay, Yeah, So the incubation period, that
Speaker 3: time from infection to symptoms usually is between five and
Speaker 3: fifteen days, but it can be quite a bit longer,
Speaker 3: like even a month or more.
Speaker 2: Gotcha.
Speaker 3: Okay, so let's talk about the symptoms of typhoid fever,
Speaker 3: shall we.
Speaker 2: Let's okay.
Speaker 3: The classic description goes something like this. It starts with
Speaker 3: a fever fever, but not just any fever, because we
Speaker 3: have to get specific. This is a fever that gets
Speaker 3: progressively worse. It's called a step ladder or a step
Speaker 3: wise fever. So once it begins, it remains high and
Speaker 3: then progressively rises over the course of or so weeks
Speaker 3: before it peaks, and then stays pretty high like a
Speaker 3: plateau phase.
Speaker 1: Huh okay, okay, like how high?
Speaker 3: Good question? Not bonkers high, Like, we're not talking one
Speaker 3: oh six, But a fever is classified as one hundred
Speaker 3: point four fahrenheit or thirty eight celsius. So it'll start
Speaker 3: there just like a low grade fever, and then progressively
Speaker 3: just get higher. I don't know what the maximum peak is,
Speaker 3: probably depends on the person, but we're not talking like
Speaker 3: one oh six one oh seven. It's just a slowly
Speaker 3: progressive fever. And what's important is that it stays high.
Speaker 3: A lot of other diseases you might have a fever
Speaker 3: for part of the day and then part of the
Speaker 3: day your temperature will go back down. With typhoid, once
Speaker 3: your fever rises, you stay with an elevated temperature. Okay, okay, okay.
Speaker 3: And the other classic symptom that's very interesting is that
Speaker 3: and oh my gosh, Aron, please don't ask me why
Speaker 3: this happens. Okay, just I'm forewarning you. But classic typhoid
Speaker 3: has what's called a relative brad acardia, So that means
Speaker 3: that your heart rate is slow. And normally, when you
Speaker 3: have a fever, a normal physiologic response would be your
Speaker 3: body going, hey, I'm feeling stressed out because my temperature's high,
Speaker 3: so my heart rate is going to increase because of
Speaker 3: that high temperature. But with typhoid, it doesn't do that.
Speaker 3: Your heart rate stays low.
Speaker 1: I am bursting with questions, how dare you censor me? Okay,
Speaker 1: I won't ask why, I will ask are there other
Speaker 1: diseases or other times that fever occurs when the same
Speaker 1: thing happens.
Speaker 3: There are some others. Absolutely, this isn't the only thing
Speaker 3: that causes this, but that's one of those classic findings. Okay, okay, Wow,
Speaker 3: I know Okay, all right, Now that's the initial phase. Okay,
Speaker 3: So it's like this two weeks of increasing fever. In
Speaker 3: the second week, people might start to get a faint
Speaker 3: rash on their trunk. There are these little salmon colored
Speaker 3: spots for sure. That's not why it's called salmonilla though. Okay.
Speaker 3: And then in the third week of illness, you often
Speaker 3: get abdominal pain. You can get either diarrhea or constipation,
Speaker 3: which is interesting. We'll talk more about that later, bleeding
Speaker 3: from the intestinal tract. Often you can get secondary bacterymia.
Speaker 3: So if this bacteria enters your bloodstream and starts to
Speaker 3: replicate in your bloodstream, that's what bacterymia is. And sepsis,
Speaker 3: almost everyone will get hepatitis and a painful hippatosplinomegaly, which
Speaker 3: is a fun word we often say on this podcast.
Speaker 3: So swelling of your liver and spleen. And now this
Speaker 3: I want to put a pin in so that you
Speaker 3: remember it because we're going to talk more about it.
Speaker 3: But salmonilla typhee is also a cause of acute coly
Speaker 3: cystitis aka gallbladder infection. Okay, that's important. Just remember it now.
Speaker 3: This is not a bacteria that tends to infect your
Speaker 3: nervous system, so neurologic manifestations are pretty uncommon. It's not impossible,
Speaker 3: but when you have them, they look more like febrile
Speaker 3: seizures and young children, which happens with a whole bunch
Speaker 3: of different diseases. And then it is possible to have
Speaker 3: other more serious complications like myocarditis, but this is really rare,
Speaker 3: so that would be if it infects your heart. But
Speaker 3: most of the time this is a gastrointestinal tract disease.
Speaker 3: So if you don't die from overwhelming sepsis and shock
Speaker 3: or from your intestines becoming perforated and just like exploding
Speaker 3: your gut juices everywhere, my god, then over a period
Speaker 3: of weeks to months, your symptoms gradually begin to resolve.
Speaker 1: If you do not die, okay, over a period of
Speaker 1: weeks to months.
Speaker 3: Weeks two months. This is a long lasting infection. So
Speaker 3: the big question in my mind is what makes Salmonella
Speaker 3: typhe so different from all the other serivars of salmonella
Speaker 3: and enterica. Right, A lot of other species of salmonilla,
Speaker 3: even salmonilla in terica, can infect us and maybe we
Speaker 3: get like the poops from it. But Salmonella typhee causes
Speaker 3: this really disseminated infection. It's mostly GI symptoms, but the
Speaker 3: first symptoms that you see are this fever, which tells
Speaker 3: us that it's affecting a lot more than just our
Speaker 3: GI tract. Yeah, so why Yeah, I ask myself the
Speaker 3: questions that I can answer. So the difference really is
Speaker 3: because Salmonella typhe is this host restricted pathogen. It can
Speaker 3: very quickly invade through our gastrointestinal walls, so it is
Speaker 3: not limited. It's not causing an infection that's only in
Speaker 3: our GI tract. Exactly how this happens, we still don't
Speaker 3: fully know, but we do know that it's at least
Speaker 3: in part due to the bacteria down regulating our immune response.
Speaker 3: So here's where it gets interesting. Okay, in our GI tract,
Speaker 3: we have these things called pyre's patches. I feel like
Speaker 3: we've talked about them a little bit on this podcast before,
Speaker 3: but they're basically like lymph nodes in the walls of
Speaker 3: our small intestine. So it's where like our white blood
Speaker 3: cells hangout. It's like the immune center of our GI tract.
Speaker 3: Our GI tract has its own little immune system.
Speaker 2: Oh, it's like a big deal.
Speaker 3: It's a very big deal. Yeah, it's very cool. So
Speaker 3: salmonella actually invades through these pyre patches. So this is
Speaker 3: the area of our small intestine where it makes its
Speaker 3: way into our body. And what's very cool is it
Speaker 3: actually uses the same channels to enter through our cells
Speaker 3: that are missing in people with cystic fibrosis, those CFTR channels, right,
Speaker 3: cystic fibrosis trans membrane receptor I think so those also,
Speaker 3: you might remember our channels that are important in another
Speaker 3: bacterial disease, cholera.
Speaker 1: Yeah, yeah, I was gonna say, isn't that when we
Speaker 1: talked about pyres patches?
Speaker 3: It could have been I don't actually remember. That was
Speaker 3: a long time ago.
Speaker 2: That was a long time ago.
Speaker 3: But so these pyres patches, which is where our white
Speaker 3: blood cells hang out in our intestine, are where salmonilla
Speaker 3: first invades. So that's where it basically makes its way
Speaker 3: through the wall of our intestine, through that epithelial cell layer,
Speaker 3: and into our bloodstream. And it gets better. Salmonilla typhee
Speaker 3: is also facultatively intracellular. What that means is it can
Speaker 3: live inside of our cells and guess which cells it
Speaker 3: likes to replicate inside of white blood cells. A white
Speaker 3: blood cell erin are macrifacious, so that is how it's
Speaker 3: able to very quickly establish an infection outside of our intestine.
Speaker 3: It invades and replicates within our own white blood cells
Speaker 3: and then travels literally wherever white blood cells go, and
Speaker 3: because of that, it tends to cause infection. So basically,
Speaker 3: it'll you get infected by eating this bacteria essentially, and
Speaker 3: then it travels through your gut into your small intestine,
Speaker 3: invades through the wall of your small intestine, makes its
Speaker 3: way into your white blood cells, travels with these white
Speaker 3: blood cells to a few specific places where white blood
Speaker 3: cells hang out the liver, the spleen, the lymph nodes,
Speaker 3: and the gall bladder, Okay, and then from all of
Speaker 3: these tissues, the bacteria is continually proliferating, it re enters
Speaker 3: the bloodstream, and that's when you start to actually see disease.
Speaker 3: So that's why you have this time lag right.
Speaker 1: Right, It's got to make all those journeys and bulk
Speaker 1: up its.
Speaker 3: Numbers exactly exactly. And then eventually, because it's infecting the
Speaker 3: liver and the gall bladder, from there, the bacteria actually
Speaker 3: re enters the intestine and that's when you start to
Speaker 3: see those abdominal symptoms. And so that's why those abdominal
Speaker 3: symptoms like diarrhea, abdominal pain is even later in the
Speaker 3: course of even though you got infected from your GI
Speaker 3: tract to begin with. Gotcha, Okay, And that's when the
Speaker 3: most serious complications and the most life threatening complication can occur,
Speaker 3: which is intestinal perforation. And the reason that that happens,
Speaker 3: and this is so bizarre, it's thought and we again
Speaker 3: still don't one hundred percent understand this, but the bacteria,
Speaker 3: once they reinfect again your intestine, cause tissue death of
Speaker 3: those piers patches. So where they initially invaded, they come
Speaker 3: back in and they kill off enough cells in the
Speaker 3: wall of your intestine that they make it so that
Speaker 3: that wall is weak and then eventually can perforate. And
Speaker 3: that has a mortality rate of like forty to eighty percent.
Speaker 1: Like that's fascinating because you would think that there would
Speaker 1: be like a trigger, like clearly they're doing something different.
Speaker 3: Mm hmm. They're totally doing something different, and it's quite rare.
Speaker 3: This only happens in like less than five percent of cases. Okay, Okay, listen,
Speaker 3: we haven't even gotten to the most fascinating part of
Speaker 3: Salmonilla typhee.
Speaker 2: I am very excited.
Speaker 3: Let's go okay, that is that so many people can
Speaker 3: become infected and maintain a chronic carrier state without ever
Speaker 3: showing symptoms of the disease. Oh yeah, okay, oh yeah.
Speaker 3: About twenty five percent of people who are chronic carriers
Speaker 3: never have any symptoms of disease. Yep, we all know this.
Speaker 3: This is the story of typhoid Mary. Aaron's gonna tell
Speaker 3: it to us in a lot more detail. But the
Speaker 3: real question that I need to answer is how on
Speaker 3: earth could Mary and others have been spreading this infection
Speaker 3: for so long without ever even knowing they were infected.
Speaker 2: It's I don't I don't know. I want to know.
Speaker 2: Tell me all right.
Speaker 3: So a proportion of people who get infected with semonel
Speaker 3: typhee won't ever show symptoms. That's fine. About three to
Speaker 3: five percent of people overall who get infected with Salmonella
Speaker 3: type go on to become chronic carriers. So where is
Speaker 3: this bacteria hanging out, whether or not you've ever shown
Speaker 3: any symptoms? And the answer is the gall bladder erin
Speaker 3: Oh okay, So in some people. And again this is
Speaker 3: also still something that we don't one hundred percent understand,
Speaker 3: but we have a much better understanding now than in
Speaker 3: Mary's time, for example.
Speaker 2: I mean, yeah, so in.
Speaker 3: We know that Salmonella type can invade the gallbladder, it
Speaker 3: can cause choliicystitis, which is like an acute infection, but
Speaker 3: in some people it can essentially start to form a biofilm.
Speaker 3: Oh so it doesn't just invade the cells of the
Speaker 3: gallbladder wall, but actually forms a its own biofilm. And
Speaker 3: this happens especially in people with gallstones, which, as it
Speaker 3: turned out, happen to be a medium on which Semonella
Speaker 3: typhee can persist and grow and form a biofilm.
Speaker 1: Is what is a gallstone made of?
Speaker 3: Often cholesterol. There's a few other things that it can be,
Speaker 3: but most of the time it's cholesterol. Okay, interesting, Yeah,
Speaker 3: so that's that's kind of the main thinking. That it's
Speaker 3: gallstone related, biofilm related, something like that. And we know
Speaker 3: that it definitely causes chronic inflammation because infection, chronic infection
Speaker 3: with Salmonella typhee is pretty strongly associated with gallbladder carcinoma,
Speaker 3: so cancer, and we know that cancer and inflammation often
Speaker 3: go hand in hand, but it's a little bit more
Speaker 3: complicated because at least in some cases, cholis systectomy, which
Speaker 3: is the surgery that we do to remove the bladder,
Speaker 3: doesn't always resolve the carrier state. Right, And also, not
Speaker 3: everyone that has gallstones becomes a typhoid carrier. A lot
Speaker 3: of people have gallstones. Not every person with gallstones that
Speaker 3: gets infected with Salmonella typhee is necessarily going to become
Speaker 3: a Salmonella typhee carrier. So we still don't fully understand
Speaker 3: the process, but we at least know more. Is it treatable, Eric, Oh,
Speaker 3: great questions. So it is treatable, and the good news
Speaker 3: is that treatment is extremely effective.
Speaker 2: That's great, it is.
Speaker 3: Yes, it's with antibiotics. Without any treatment. Typhoid has a
Speaker 3: mortality rate of between ten to thirty percent, so pretty
Speaker 3: deadly disease.
Speaker 1: Very deadly, Like uh wow.
Speaker 3: Right, with treatment, mortality rates estimates are like one percent,
Speaker 3: so still not perfect, and I would say one percent
Speaker 3: is still pretty high, but that's what the kind of
Speaker 3: global estimates are. And we'll talk a lot in the episection,
Speaker 3: but the short answer is, like we have a very
Speaker 3: poor understanding of the global incidence of typhoid fever.
Speaker 2: Yeah, okay, I kind of figured that.
Speaker 3: Yeah, very poor understanding. The good news is that in
Speaker 3: addition to treatment, there are vaccines. There are two different
Speaker 3: vaccines that are widely available. One is a polysaccharide, so
Speaker 3: it's like a sugar that's found on the outside of
Speaker 3: the bacteria that can be used starting in children at
Speaker 3: age two. And children are important because a lot of
Speaker 3: typhoid fever happens in children. It's really a disease of
Speaker 3: childhood in a lot of places. That one has to
Speaker 3: have boosters every two years because it doesn't have a
Speaker 3: very long lasting immunity. And then there's a live attenuated vaccine,
Speaker 3: so it's a live bacteria that they've grown in a
Speaker 3: lab to be less virulent so it doesn't cause severe illness,
Speaker 3: but it still gives you protection. That one you can't
Speaker 3: give it to kids under six, so it's only for
Speaker 3: older kids and adults, and it needs boosters every five years.
Speaker 3: But we'll talk in the current events about a very
Speaker 3: exciting new vaccine. Oh that's super new, that's very exciting.
Speaker 2: That's fun.
Speaker 3: We can't talk about it yet.
Speaker 4: So aarin, where did this bacteria come from what's it
Speaker 4: doing to us?
Speaker 1: I am very excited because this is going to be
Speaker 1: a good one, but we have to take a short
Speaker 1: break first, definitely. So I talked a little bit at
Speaker 1: the very beginning of the episode about why we are
Speaker 1: so excited to do this topic typhoid. And so not
Speaker 1: only is this like the full circle moment of like, oh,
Speaker 1: you know, we're finally doing the thing that like totally
Speaker 1: changed our lives forever thanks to Georgia and Karen on
Speaker 1: My Favorite Murder, but also typhoid fever is like first
Speaker 1: season TPWKY Totally, It's like a big deal.
Speaker 2: It's a classic disease. It's like one of the you know,
Speaker 2: big names.
Speaker 3: In I'm expecting like Ebers, Papyrus, Ancient rom et cetera,
Speaker 3: et cetera, poopinin holes, all of it.
Speaker 1: I mean, we we've already got the poopinin holes. So
Speaker 1: it started off good, let's just see what else we've
Speaker 1: got here. But you know, in addition to that, I
Speaker 1: as I read more about the history of typhoid, and
Speaker 1: particularly Mary Mallin, who was who gave rise to the
Speaker 1: term typhoid Mary, I realized just how relevant her story
Speaker 1: is to what's going on today and the enormous conflict
Speaker 1: between public health and civil liberties that can emerge sometimes.
Speaker 1: And finally, just how important science education and science literacy
Speaker 1: is to reducing that conflict.
Speaker 2: Yeah, okay, so let's dive in.
Speaker 3: Let's do it.
Speaker 1: You can probably guess that typhoid fever has been around
Speaker 1: for millennia yep. Evolutionarily speaking, some researchers believe that it
Speaker 1: originated in Indonesia, like thousands and thousands of years ago,
Speaker 1: but it would have spread pretty easily and rapidly around
Speaker 1: the world as travel became more widespread. And one interesting
Speaker 1: thing to note is that there doesn't seem to be
Speaker 1: a whole lot of genetic variation among strains geographically, with
Speaker 1: the exception of antibiotic resistance strains, which is thought to
Speaker 1: point towards the importance of carriers in perpetuating the disease.
Speaker 2: Ah, if that makes sense.
Speaker 1: So, like there's not a whole lot of like selection
Speaker 1: pressure by which hosts survive or whatever, because carriers are.
Speaker 3: There, right, there's always carriers to just sort of keep
Speaker 3: the disease slowly moving through population ye and around the world.
Speaker 2: Really interesting that I never.
Speaker 3: Thought about being able to. Yeah, yeah, that's pretty cool.
Speaker 1: It's cool. And I know that you were hoping for
Speaker 1: like the Ebers Papyrus and you know, ancient Roman stuff. Yeah,
Speaker 1: and so like, I can't explicitly say, no, it wasn't
Speaker 1: written about, but you know, it's a very like as
Speaker 1: a gi illness. It's like fairly you know, it's one
Speaker 1: of many people had a lot of running poops and
Speaker 1: like died from diarrhea all the time.
Speaker 3: They weren't writing about a step wise fever and relative
Speaker 3: bratocardia in the ever'spyros.
Speaker 2: Don't be shieve that they were.
Speaker 1: I don't believe so. So anyway, so it wasn't explicitly
Speaker 1: described by a lot of ancient Greek or Roman physicians,
Speaker 1: but I mean undoubtedly it was around right for centuries.
Speaker 1: Its name typhoid was used to describe more a set
Speaker 1: of symptoms rather than a separate disease. Typhoid actually means
Speaker 1: it just means typhus.
Speaker 3: Like and interesting.
Speaker 1: Yeah, And I just want to give a little bonus
Speaker 1: factoid even though we're gonna cover typhus at some point
Speaker 1: in the future, because that's another big that's another big
Speaker 1: like Season one era kind of twky. I'm just gonna
Speaker 1: tell you the etymology of typhus now, because to say, oh,
Speaker 1: it's typhus like and then move.
Speaker 3: On at least really Yeah.
Speaker 1: Basically, typhus comes from the Greek typhos, meaning stupor caused
Speaker 1: by fever. It's also related to smoke or mist or fog,
Speaker 1: referring to the brain fog that's associated with typhus and
Speaker 1: occasionally with typhoid. Okay, So, because of its similarity to
Speaker 1: other gi illnesses, it's hard to pinpoint specific typhoid epidemics
Speaker 1: or estimate its impact separate from other illnesses caused by
Speaker 1: poor sanitation or clean water infrastructure. But that doesn't mean
Speaker 1: people won't try to ascribe typhoid as causes of epidemics
Speaker 1: in history.
Speaker 3: It's my favorite thing.
Speaker 1: For instance, Alexander the Great may have died of typhoid
Speaker 1: at the age of thirty two. What Yeah, he was
Speaker 1: only thirty two.
Speaker 3: He's only thirty two.
Speaker 2: I know, Oh, I know.
Speaker 1: It also could have been I will note poisoning, malaria, brucellosis.
Speaker 2: Et cetera.
Speaker 1: And typhoid has also been blamed for the plague of Athens,
Speaker 1: which happened in four hundred and thirty BCE during the
Speaker 1: Peloponnesian War between.
Speaker 2: Athens and Sparta.
Speaker 1: Okay, this epidemic, the plague of Athens, killed approximately one
Speaker 1: third to two third of the population of Athens, including
Speaker 1: the leader Pericles, and about one fourth of the army,
Speaker 1: basically sealing the fate of Athens.
Speaker 2: But it was it actually typhoid?
Speaker 1: Probably not, so there was, and the reason that people
Speaker 1: think it was is because there was an article reporting
Speaker 1: Salmonella enterica genetic material in ancient DNA samples of likely victims.
Speaker 1: But those findings have been highly criticized. Okay, smallpox, typhus,
Speaker 1: and measles are also decent contenders, with of course, the
Speaker 1: possibility that it was a totally different pathogen that's no
Speaker 1: longer circulating, right, Yeah, But what is definitely true again
Speaker 1: is that typhoid was an infamous killer during wartime or
Speaker 1: times of unrest, primarily because of poor hygiene and a
Speaker 1: lack of clean water made transmission easy, as you heard
Speaker 1: in the first hand snippets, and add on to that
Speaker 1: a lack of knowledge about germ theory and how the
Speaker 1: disease is transmitted, and you have a recipe for disaster.
Speaker 2: In the Jamestown Colony.
Speaker 1: Oh, typhoid was responsible for wiping out an estimated sixty
Speaker 1: five hundred of seventy five hundred.
Speaker 2: Colonists in the early sixteen hundreds. Oh, yeah, a lot.
Speaker 1: I mean, you know, they weren't They also weren't in
Speaker 1: the best like they weren't in the best health otherwise,
Speaker 1: the right.
Speaker 3: That's the thing I mean, yeah.
Speaker 1: I mean it was sort of like it was a
Speaker 1: what did they call it in some of these descriptions,
Speaker 1: It was like a seasoning, Like you had to get
Speaker 1: there and it was like you had to go through
Speaker 1: this hazing of a disease, like the seasoning of a disease.
Speaker 1: I don't know how else to say it. But you
Speaker 1: either survived or you didn't, right, Yeah, I mean that
Speaker 1: was like all of childhood for so many thousands of years.
Speaker 3: Yep.
Speaker 1: Yeah. Population growth in the major cities during the Industrial
Speaker 1: Age way outpaced the infrastructure or knowledge or technology to
Speaker 1: manage the waste that was being produced, and this is
Speaker 1: reflected in the annual incidents of typhoid in Europe during
Speaker 1: this period, which was about one in two hundred people.
Speaker 2: Wow, it's really high.
Speaker 3: That's really high.
Speaker 2: Yeah.
Speaker 1: Albert Prince Consort of Queen Victoria, died in eighteen sixty
Speaker 1: one of probably typhoid, and President William Henry Harrison, who
Speaker 1: was the ninth and shortest serving US president, died from
Speaker 1: what was likely typhoid, just thirty one days after taking office.
Speaker 3: He was also a.
Speaker 1: Terrible person, he was. He was the twelfth The US president.
Speaker 1: Zachary Tyler may also have died from typhoid, and three
Speaker 1: of Louis Pasture's five children died.
Speaker 2: From typhoid fever apparently. Oh yeah, so this was an.
Speaker 1: Enormously feared disease, and it was one that did not
Speaker 1: respect divisions of class or wealth. Starting in the eighteenth century,
Speaker 1: physicians began to observe or describe that typhoid and typhus
Speaker 1: were two different diseases. Several physicians noted the difference in
Speaker 1: fever intensity or duration, or siclicity, etc. Or noted the
Speaker 1: lesions in the pyre's patches of the small intestine. Confusion lingered, though,
Speaker 1: especially in the diagnosis of non fatal cases of typhoid.
Speaker 1: In eighteen thirty seven, two Philadelphia physicians, William Gerhard and
Speaker 1: Casper Pennock published their observations that typhoid and typhus were
Speaker 1: distinct diseases. An epidemic of typhus in eighteen thirty six
Speaker 1: allowed them to note not only how the diseases behave differently,
Speaker 1: so like typhus was more likely to cause an epidemic
Speaker 1: and much less likely to appear in sporadic cases, as
Speaker 1: well as how their pathophysiology differed. But there was still
Speaker 1: a major piece of the puzzle missing. How was typhoid
Speaker 1: fever transmitted. Yeah, at this time, which was the first
Speaker 1: half of the nineteenth century, germ theory had not yet
Speaker 1: been developed, although the concept of contagion was well established.
Speaker 4: I feel like that's what makes it so classic TPWKY
Speaker 4: like getting to talk about nobody knew germ theory and
Speaker 4: then we learned about germ theory, you know, that's like
Speaker 4: very classic.
Speaker 1: It is it is I feel like also, I'm like,
Speaker 1: I hope people aren't sick of hearing about like the
Speaker 1: era of germ theory and like it just it is
Speaker 1: now such a mind blowing like the revolution of awareness
Speaker 1: of the world around us.
Speaker 3: So wise, it is just like you talked about in
Speaker 3: the Giardia episode when Van Lewin Hook looked through his
Speaker 3: microscope and saw the whole world in the water like
Speaker 3: it is. It is mind blowing and phenomenal to think
Speaker 3: about the time of that shift mindset. It is absolutely fascinating. Good.
Speaker 1: Well, I'm glad you're not sick of it, because I'm
Speaker 1: not telling it either.
Speaker 3: And we make the rules around here.
Speaker 1: So so yeah, so people knew, maybe not about microbes,
Speaker 1: but they knew about contagion and that concept. And the
Speaker 1: English physician William bud And I highly recommend you check
Speaker 1: out his Wikipedia page just so you can see his
Speaker 1: incredible facial hair. He discovered the link between typhoid and
Speaker 1: fecal oral water contamination after tracing one outbreak of the
Speaker 1: disease in a village in eighteen forty seven and finding
Speaker 1: that the only link between the households was that they
Speaker 1: shared a well. And then later, like years later, after
Speaker 1: learning about John Snow's work between cholera and the Broad
Speaker 1: Street pump, he became even more convinced that contaminated water
Speaker 1: was the source of typhoid outbreaks.
Speaker 3: I was just about to ask what time was this
Speaker 3: in relation to John Snow and cholera.
Speaker 1: I love it, And just like with cholera, there may
Speaker 1: have been some resistance and accepting that water, not bad air,
Speaker 1: could be the cause of so much illness and death.
Speaker 1: But if there was resistance in the face of typhoid
Speaker 1: fever and transmission, it was fairly short lived. As I mentioned,
Speaker 1: the massive global population growth had led to an equally
Speaker 1: massive waste problem. In London in July and August of
Speaker 1: eighteen fifty eight, for instance, I mean, you heard the
Speaker 1: first hand of cholera. It's a pretty like memorable. The
Speaker 1: poop and trash in the River Thames baking in the
Speaker 1: summer sun led to such an overwhelming foul smell that
Speaker 1: it was called the Great Stink. There's an entire Wikipedia
Speaker 1: page about it. And I really I just want to
Speaker 1: read this. This is just an episode of growth stuff.
Speaker 1: So I wanted to read this excerpt from a contemporary
Speaker 1: newspaper about the Great Stink. Yes, quote, For the first
Speaker 1: time in the history of Man, the sewage of nearly
Speaker 1: three million people had been brought to seethe and ferment
Speaker 1: under a burning sun in one vast open kloaka, lying
Speaker 1: in their midst I can't see, ah, I have to
Speaker 1: try that again. I can't say open Kloaca without a spark,
Speaker 1: without laughing.
Speaker 3: Over kaka, oh dear.
Speaker 1: In one in one vast open kloaka lying in their
Speaker 1: midst The result we all know, stench so foul, we
Speaker 1: may believe, had never before ascended to pollute the lower air.
Speaker 1: Never before, at least had a stink risen to the
Speaker 1: height of a historic event.
Speaker 2: Do you see why I needed to read that?
Speaker 3: Yes, I agree with it. It was the correct decision.
Speaker 1: Yeah, so jack out the Wikipedia.
Speaker 2: What a time.
Speaker 1: Events like the Great Stink and the cholera epidemics finally
Speaker 1: forced public officials to recognize contaminated water was a public
Speaker 1: health issue, and this was only deepened with the development
Speaker 1: of germ theory. Side note, the Chicago River was reversed
Speaker 1: to try to control the outbreaks of typhoid and kara
Speaker 1: whoa cool? Okay, So hopefully by now I have painted
Speaker 1: somewhat of a picture of the prominence or infamy of
Speaker 1: typhoid through the eighteen hundreds, so that you can understand
Speaker 1: why isolating the causative agent became a top priority for
Speaker 1: so many bacteriologists.
Speaker 3: Yeah, definitely, And because.
Speaker 1: Of its prevalence and popularity in research, it's a bit
Speaker 1: tough to establish priority on who first discovered the bacterium.
Speaker 1: One likely suspect was the Polish scientist oh Boy Tadoos Brawitz,
Speaker 1: who described rod shaped bacteria in the organs of people
Speaker 1: infected with typhoid, and he even isolated and cultured the bacteria,
Speaker 1: but he never followed through by trying to determine whether
Speaker 1: those cells were responsible for the disease itself.
Speaker 3: Got it, He never did all of the Postulitz right.
Speaker 1: Credit is usually given to German pathologist Carl Eberth for
Speaker 1: first isolation, and this is reflected in the fact that
Speaker 1: the first name given to the bacterium.
Speaker 2: Was Eberthella Eberthella.
Speaker 3: Okay.
Speaker 2: The rest of the late.
Speaker 1: Eighteen hundreds and early nineteen hundreds was a busy in
Speaker 1: productive time for typhoid researchers. The development of the Widel
Speaker 1: test allowed physicians to test for the typhoid bacterium. Basically,
Speaker 1: you take serum from a suspected patient and see how
Speaker 1: it reacts when exposed to a culture of the bacteria.
Speaker 1: If a precipitate forms, you've got typhoid, and then the
Speaker 1: vaccine was next. Just like with a discovery and description
Speaker 1: of the typhoid bacterium itself, There seems to be some
Speaker 1: debate over who first created the typhoid vaccine. Many different
Speaker 1: people at least had a hand in it. Credit usually
Speaker 1: goes to Sir Almroth Wright, who was an English pathologist,
Speaker 1: and he began testing an early typhoid vaccine on army
Speaker 1: officers in the Indian Medical Service.
Speaker 2: Not for effectiveness against typhoid though, but yeah.
Speaker 1: But rather to see whether calcium chloride prevented hemorrhaging in
Speaker 1: those injected. What as like an additive or stabilizer.
Speaker 3: So he made a whole new vaccine and was like,
Speaker 3: I'm not testing this vaccine. I just want to test
Speaker 3: the adjuvant.
Speaker 1: I don't get it, but he usually gets credited for
Speaker 1: the first typhoid vaccine, even if many others paved the
Speaker 1: way for him. And he followed up his first tiny
Speaker 1: test with more extensive testing, this time to actually observe
Speaker 1: the efficacy of the vaccine in protecting against disease.
Speaker 3: Oh what a concept.
Speaker 2: What a concept.
Speaker 1: But instead of exposing the participants to typhoid, which was,
Speaker 1: as we know, a method still occasionally practiced like you know,
Speaker 1: actual challenge or whatever, he tested the serum of those
Speaker 1: vaccinated to see whether typhoid bacteria.
Speaker 2: Would agglutinate, so kind of smart. Yeah, I'm pretty smart.
Speaker 1: And sure enough, the serum of those vaccinated did seem
Speaker 1: to agglutinate bacteria, but did that translate into actual protection
Speaker 1: in the body. The bacteria in the precipitates.
Speaker 2: Were still viable after all.
Speaker 1: So they did the unethical thing and exposed one of
Speaker 1: the participants to typhoid, and fortunately he did not get it.
Speaker 1: The development of a typhoid vaccine completely changed war.
Speaker 2: Yeah.
Speaker 1: I've talked before on the podcast about just how much
Speaker 1: death and illness during war comes from infection rather than combat,
Speaker 1: But I didn't realize just how much typhoid was often
Speaker 1: responsible for the most damage.
Speaker 3: Yeah. I don't think I would have put that together necessarily.
Speaker 1: Yeah, I mean, and it makes sense given like the
Speaker 1: conditions of living and so on, and like how do
Speaker 1: you prepare food in a clean way?
Speaker 2: How do you poop in a clean way? Like how
Speaker 2: do you.
Speaker 1: Clean yourself in a clean way?
Speaker 3: Yeah?
Speaker 2: Yeah.
Speaker 1: During the American Civil War, for instance, eighty thousand of
Speaker 1: the two million soldiers in a Union army there were
Speaker 1: no good records for the Confederate army got typhoid. About
Speaker 1: five percent.
Speaker 3: Yeah.
Speaker 1: And in the Spanish American War, which is where the
Speaker 1: first hand accounts came from, approximately twenty one thousand troops
Speaker 1: were infected with typhoid and nearly sixteen hundred died.
Speaker 3: Wow.
Speaker 2: Yeah, it's a lot.
Speaker 1: Most of the time, typhoid killed more soldiers than direct combat.
Speaker 4: Yeah.
Speaker 3: I feel like that's a theme that we often come
Speaker 3: back to, is it's not funly, it's awful.
Speaker 1: World War One would be the first major conflict in
Speaker 1: which typhoid did not contribute enormously to the death toll
Speaker 1: because of the vaccine, Because of the vaccine, Because of
Speaker 1: the vaccine. In previous wars, the attack rate of typhoid
Speaker 1: was estimated to be one in five, but that dropped
Speaker 1: to one in two thousand by World War One due
Speaker 1: to the vaccine and improvements into panitation practices.
Speaker 3: What that's bonkers, I know.
Speaker 2: Yep, it's pretty clear.
Speaker 3: The phenomenal Wow, huge, huge, Wowee.
Speaker 1: All right, here we are in the early nineteen hundreds.
Speaker 2: We're finally here.
Speaker 3: We're finally here.
Speaker 1: I just want to set the stage a bit for
Speaker 1: this next part of the story of typhoid.
Speaker 2: Yes, so typhoid has.
Speaker 1: Been a commonplace, but still very much fear disease for
Speaker 1: the past centuries, and while there have been some major
Speaker 1: developments in understanding its transmission and path of physiology, both
Speaker 1: sanitation infrastructure and medical treatments a life behind. So the
Speaker 1: threat remains. A doctor can diagnose a case, but they
Speaker 1: can't treat it because antibiotics haven't been discovered yet. A
Speaker 1: typhoid vaccine did exist, but they were new and not
Speaker 1: trusted and generally reserved for the military, and cities began
Speaker 1: to grow at incredible rates.
Speaker 2: All that poop with nowhere to go.
Speaker 3: Uh.
Speaker 2: Enter Mary Mallin.
Speaker 1: Mary Mallan emigrated to the US from Ireland in eighteen
Speaker 1: eighty three at the age of fifteen and began working
Speaker 1: as a cook, and she seemed to be really good
Speaker 1: at it. She seemed to be in steady employment in
Speaker 1: the New York City area with short term contracts, working
Speaker 1: for wealthy families from season to season, and that was
Speaker 1: like a normal thing for a lot of cooks, just
Speaker 1: like contract work. Mary's life continued in this rhythm for
Speaker 1: twenty and some years until the events that would turn
Speaker 1: her from Mary Mallin to the infamous typhoid Mary.
Speaker 3: So she was like in her late thirties like, yes,
Speaker 3: mid to late thirties. Yes.
Speaker 1: In nineteen oh six, an outbreak of typhoid occurred among
Speaker 1: the household of the wealthy New York City banker Charles
Speaker 1: Henry Warren, who was renting a summer home in Oyster
Speaker 1: Bay in New York. Two of his daughters, his wife,
Speaker 1: two maids, and the gardener all became sick. Isolated outbreaks
Speaker 1: like this did happen from time to time, but this
Speaker 1: was still a huge cause for concern, not.
Speaker 2: Just because the disease could be fatal, but.
Speaker 1: Because an outbreak of typhoid could tarnish a homeless reputation
Speaker 1: for years because it suggested that the waterlines weren't clean.
Speaker 3: I'm scuffing my face at that.
Speaker 2: I know that was a very good scoff face.
Speaker 1: I wish that I had taken like a screenshot of
Speaker 1: it or something. So the owners of the house were
Speaker 1: desperate to trace where the outbreak originated.
Speaker 3: I mean, okay, yeah, I.
Speaker 1: Mean it makes sense, like you want to know, like, okay,
Speaker 1: if we can put a stop to this, let's put
Speaker 1: a stop to this.
Speaker 3: Of course, and it is very deadly in that, but
Speaker 3: like the reputation thing, like.
Speaker 1: Well, I mean, they were like, well, we need to
Speaker 1: make sure to rent our our h.
Speaker 2: I R B and b our. I'm pretty sure I
Speaker 2: stole that joke from the good place.
Speaker 3: It's a good one though.
Speaker 1: Yeah.
Speaker 2: Okay.
Speaker 1: Anyway, so these owners hired George Soper, a sanitary engineer.
Speaker 3: Okay, cool.
Speaker 1: His job was basically a mix of health inspection and
Speaker 1: shoe leather epidemiology.
Speaker 3: Awesome.
Speaker 1: Yeah, And he went around the entire property on Oyster
Speaker 1: Bay looking to see whether the toilet waste ran into
Speaker 1: the water sources or if the local oysters from Oyster
Speaker 1: Bay were contaminated, and he found nothing. Okay, but the
Speaker 1: typhoid had to come from somewhere, and the source had
Speaker 1: to be unique to that household since no other cases
Speaker 1: were detected in the nearby town, soaper learned that the
Speaker 1: family had hired a new cook just before the outbreak started.
Speaker 2: That cook's name was.
Speaker 3: Mary Mary Mallan.
Speaker 1: At first, it may have been hard to see how
Speaker 1: a cook could be the source of a typhoid outbreak,
Speaker 1: since the bacteria would be killed during the heating process,
Speaker 1: but then it was revealed that one of Mary's most
Speaker 1: popular dishes was ice cream and fresh peaches boom.
Speaker 3: How sad? Like what a great that sounds like such
Speaker 3: a good dessert.
Speaker 1: I mean, we probably should have made a quarantine that
Speaker 1: was like peach and ice cream themes.
Speaker 3: We totally should.
Speaker 1: But like bloody typhoid Mary, what else were we going
Speaker 1: to do that come up?
Speaker 3: Also, the other thing is that where can you get
Speaker 3: peaches in November in this hemisphere? You cannot, So we
Speaker 3: couldn't have taken a photo.
Speaker 2: It would be sad peaches for sure.
Speaker 3: Very sad.
Speaker 1: Yeah so yeah, yeah, well but as you can imagine
Speaker 1: ice cream in peaches, there's not a whole lot of
Speaker 1: heat in activation.
Speaker 3: A no, that would happened.
Speaker 1: And during the time that Soper was investigating this source
Speaker 1: of this outbreak, the existence of typhoid carriers had been
Speaker 1: hypothesized and observed, but it was not like a super
Speaker 1: widely known concept.
Speaker 3: Interesting. Yeah.
Speaker 1: Nevertheless, Soper became convinced that Mary was the one to blame.
Speaker 1: But there was one major problem because Mary had already
Speaker 1: moved on. She had gotten a new job and had
Speaker 1: left no forwarding address. Oh so, Soaper set to investigating
Speaker 1: her past employment to see whether she was linked to
Speaker 1: any other typhoid outbreaks. He became a bit obsessed because
Speaker 1: he essentially thought, Okay, if I can show that she
Speaker 1: is the cause of all of these cases, then that's
Speaker 1: my career made.
Speaker 2: Boom done. Huh, Like it was his ticket to fame.
Speaker 2: So anyway, okay.
Speaker 1: But what he found was that in seven of the
Speaker 1: eight families that Mary had worked for over the years,
Speaker 1: there had been a typhoid outbreak during or right after
Speaker 1: her employment.
Speaker 3: Wow.
Speaker 1: Yeah, seven of the eight, and so were finally caught
Speaker 1: up to her in nineteen o seven amidst another typhoid
Speaker 1: outbreak in the family that she was cooking for, and
Speaker 1: this one resulted in the first death definitively linked to Mary.
Speaker 2: It was the daughter of that family.
Speaker 1: Unfortunately, Mary didn't write or talk extensively about what happened
Speaker 1: from her perspective, so we have to rely on the
Speaker 1: words of contemporary sources, including George Soper. He wrote his
Speaker 1: account of events in which he and most subsequent retellings,
Speaker 1: secluding this one, he framed it like a detective story,
Speaker 1: with Mary as the villain at the center of it.
Speaker 1: Right in nineteen oh seven, when Soaper tracked down Mary's
Speaker 1: current place of employment and learned of the typhoid outbreak
Speaker 1: currently occurring. He essentially stormed right in, pointed a finger
Speaker 1: at her, and loudly accused her of making everyone around
Speaker 1: her sick with her unclean habits and carelessness.
Speaker 3: Like that's how. He just walked in out of nowhere
Speaker 3: off the street and was like, you're filthy and killing
Speaker 3: people with your pep hands.
Speaker 1: Yeah, you're you're the cause, Like you're the reason people
Speaker 1: are dying.
Speaker 3: Geez.
Speaker 1: And then and then he was like, and you know what,
Speaker 1: I need a poop sample from you right now.
Speaker 3: Good luck, buddy.
Speaker 1: So Mary was like, excuse me. And he also after
Speaker 1: demanding this fecal sample, it's not like he was like, oh,
Speaker 1: this is how it might work. This is what a
Speaker 1: typhoid carrier is, right listen, we know that you didn't
Speaker 1: mean any harm, like we're just trying to was to
Speaker 1: the root of this.
Speaker 3: There was no humanity, is what I feel like you're
Speaker 3: saying in his response, like there was no humanity whatsoever.
Speaker 2: Absolutely not.
Speaker 1: And Mary was like, excuse me, excuse me, And so
Speaker 1: she grabbed a carving fork, according to Soper, and charged him.
Speaker 1: So he ran away.
Speaker 2: He ran he ran away.
Speaker 1: Yeah, m oh my gracious, but sober didn't give up. Instead,
Speaker 1: he found out where she lived, and she was living
Speaker 1: as an unmarried woman with a disreputable boyfriend and a
Speaker 1: big dog, which Soper felt important to note big stinky dog,
Speaker 1: which like, is probably a really cute dog.
Speaker 3: Yeah, I bet it was like shaggy and druly and nice.
Speaker 2: Oh what sounds sweet?
Speaker 1: And so he went to where she lived and tried
Speaker 1: to get a fecal sample from her, and then tried
Speaker 1: to befriend the boyfriend to try to be like, let's
Speaker 1: trick Mary into giving a fecal sent.
Speaker 3: Like, what is this dude's damage? Man, I don't know,
Speaker 3: I don't know.
Speaker 1: And every time Mary just shut down, crossed her arms
Speaker 1: and was like leaf just set and packing every single time.
Speaker 2: It makes sense, right.
Speaker 1: And eventually though, he got the New York City Health
Speaker 1: Department involved, including a doctor Sarah Josephine Baker, who was
Speaker 1: a huge figure in infant and maternal health, and so
Speaker 1: she was sent to reason to try to reason with
Speaker 1: Mary more calmly. Instead, Mary ran away and hid for hours,
Speaker 1: but eventually her hiding place was found out and she
Speaker 1: was dragged literally kicking and screaming, to the hospital where
Speaker 1: she would be forced to provide samples. Sure enough, she
Speaker 1: was teeming with a typhoid bacteria.
Speaker 3: Do you have a number on that?
Speaker 1: Erin, I'm sorry, Aaron, let me just google that real quick.
Speaker 2: We don't one. No, but.
Speaker 1: Okay, so but yeah, so she was the first carrier
Speaker 1: described no definitive carrier.
Speaker 2: Yeah.
Speaker 1: So, because she was considered a flight risk, she was
Speaker 1: held in the hospital and then moved to North Brother Island,
Speaker 1: where there was a hospital that started out as a
Speaker 1: smallpox isolation building but then turned into a any disease
Speaker 1: we choose isolation building, so like tuberculosis, leprosy, et cetera.
Speaker 1: And Soper tried to convince Mary to have her gallbladder removed,
Speaker 1: even though a a surgery in the early nineteen hundreds
Speaker 1: was like super.
Speaker 3: Dangerous, yea, almost certainly death.
Speaker 1: Like no antibiotics and b its. Removal, like you said,
Speaker 1: was no guarantee that she would then be typhoid free
Speaker 1: and so but she was like, no, I don't want that,
Speaker 1: and so then he was like, all right, well, then
Speaker 1: I'm going to write a book about you and I'll
Speaker 1: split the profits with you if you promised to stop cooking,
Speaker 1: And she was like no, She basically just refused to
Speaker 1: talk to him, and she remained an isolation and her
Speaker 1: fecal samples were regularly checked for the presence of the bacteria,
Speaker 1: which were found more often than not, although there were
Speaker 1: some negative days. In nineteen oh nine, so that's two
Speaker 1: years and three months after she was first isolated, she
Speaker 1: filed a lawsuit for her release, saying that her imprisonment
Speaker 1: was unlawful and stripped her of her civil liberties. And
Speaker 1: it was at this time that the term typhoid Mary coined.
Speaker 1: In nineteen oh eight, at the annual meeting of the
Speaker 1: American Medical Association, like when they presented her carrier status,
Speaker 1: this term reached the general public over all. The tone
Speaker 1: of the articles were very sympathetic to marry. Her imprisonment
Speaker 1: to the general public was seen as a violation of
Speaker 1: civil rights and prejudice against a poor immigrant woman. But
Speaker 1: this case took place at a time when courts tended
Speaker 1: to rule in favor of social protections rather than individual rights.
Speaker 1: Interesting for instance, just a few years before, in the
Speaker 1: nineteen oh five decision Jacobson versus Massachusetts, the Supreme Court
Speaker 1: unanimously ruled that required smallpox vaccination did not violate individual rights.
Speaker 3: Quote.
Speaker 1: The liberty secured by the Constitution does not import an
Speaker 1: absolute right in each person to be at all times
Speaker 1: and in all circumstances wholly freed from restraint. Basically, the
Speaker 1: ruling was that if by exerting your own individual rights
Speaker 1: you are impinging on the rights or health of others,
Speaker 1: the no, you cannot do that.
Speaker 2: Those are not rights. That's how it's always been.
Speaker 1: Yeah, and so Mary lost this suit and continued to
Speaker 1: be held in a custody of the Board of Health
Speaker 1: of the City of New York, but not for very long.
Speaker 1: The following year, in nineteen ten, she was released on
Speaker 1: the condition that she promised not to work as a
Speaker 1: cook anymore and to report back to be tested. She
Speaker 1: agreed to the terms and then promptly disappeared and never
Speaker 1: went back for checkups. She was rediscovered in nineteen fifteen.
Speaker 1: Soaper had resumed his work as a sanitary engineer and
Speaker 1: was in the process of investigating an outbreak of typhoid
Speaker 1: at Sloane Maternity Hospital when he learned that some of
Speaker 1: the staff referred to a typhoid Mary Cook, who seemed
Speaker 1: linked to the outbreak. He was like, this is are
Speaker 1: you serious, like, is this Who am I going to find?
Speaker 1: Am I actually going to find Typhoid?
Speaker 3: Mary?
Speaker 1: Am I going to find Mary Mallin? And it was,
Speaker 1: but Mary Mallin had been going by a different name.
Speaker 1: Turned out Mary had not upheld her end of the
Speaker 1: deal continued to seek out employment as a cook, which
Speaker 1: was likely the only profession that she had any skill
Speaker 1: or experience in. Since her nineteen oh nine case had
Speaker 1: put her name out there and gained her some notoriety,
Speaker 1: she couldn't use her real name to get employment, and
Speaker 1: when Mary was apprehended the second time, she did not
Speaker 1: receive the same level of public sympathy. The New York
Speaker 1: City Health Department placed her in forceful isolation again on
Speaker 1: North Brother Island in the East River, where she would
Speaker 1: live out the rest of her days over twenty years,
Speaker 1: never admitting or acknowledging her role as carrier. She did
Speaker 1: have a few friends on the island, and apparently a
Speaker 1: little fox terrier, and she worked a bit in the
Speaker 1: bacteriology lab, but she never felt she belonged on North
Speaker 1: Brother Island and felt that her freedom had been taken
Speaker 1: away unfairly. She died at the age of sixty nine
Speaker 1: on November eleventh, nineteen thirty eight, of pneumonia following a stroke.
Speaker 1: In total, Mary was linked two fifty three cases and
Speaker 1: three deaths, although it's possible that the actual numbers were higher.
Speaker 1: The impact that Mary Mallin had on the world goes
Speaker 1: way beyond the people she infected.
Speaker 3: Yep.
Speaker 1: And I had a hard time putting all of my
Speaker 1: thoughts and feelings about Mary Mallin and typhoid Mary into
Speaker 1: one coherent thesis.
Speaker 2: So I decided to.
Speaker 1: Make a list of the different themes or lessons or
Speaker 1: whatever of the story. The first theme was probably also
Speaker 1: the earliest and the simplest, just medical mystery, epidemiological detective work.
Speaker 2: Who done it right?
Speaker 1: Yeah, boom, that's one story that people use. Number two
Speaker 1: the concept of a super spreader. The term typhoid Mary
Speaker 1: was in popular use even before this pandemic, and so,
Speaker 1: like you know, even before, we use it as someone
Speaker 1: who unknown or knowingly infected a bunch of people with something.
Speaker 3: Without seeming like they were sick or anything like.
Speaker 2: That, exactly.
Speaker 1: Number three, discrimination and oppression. Mary belonged to a few
Speaker 1: groups that have been historically very much discriminated against. Here
Speaker 1: in the US, Mary was poor she was an immigrant,
Speaker 1: and she was an unmarried woman who did not fit
Speaker 1: the contemporary standards of femininity. In Soaper's words, quote, those
Speaker 1: who knew her best in the long years of her
Speaker 1: custody said Mary walked more like a man than a woman,
Speaker 1: and that her mind had a distinctly masculine character like Okay, George, Okay,
Speaker 1: bity and Mary Mallin wasn't the only typhoid carrier in
Speaker 1: New York City, definitely not. In the years after she
Speaker 1: was imprisoned, at least fifty additional carriers had been identified,
Speaker 1: and one estimate from nineteen nineteen put New York City
Speaker 1: as having over twenty five typhoid carriers. What Some who
Speaker 1: had been identified became repeat offenders like Mary, but no
Speaker 1: one None of them faced a similar lifetime imprisonment. What
Speaker 1: Most of them were given alternative jobs or means for
Speaker 1: providing for their family. But Mary wasn't considered a breadwinner
Speaker 1: because she had no family.
Speaker 3: Because she was just a single woman in their eyes.
Speaker 2: Mm hmm.
Speaker 1: Maybe she was put on an island to serve as
Speaker 1: an example. But although Mary's punishment may have been so
Speaker 1: extreme because of who she was or what she represented,
Speaker 1: the unavoidable fact that I keep coming back to is
Speaker 1: that her actions, particularly her deliberate choice to keep working
Speaker 1: as a cook, directly caused the illnesses and deaths in others,
Speaker 1: Which brings me to theme number four and the one
Speaker 1: I think has the most relevance for today, that of
Speaker 1: the tension between individual rights and public health, was Mary's
Speaker 1: imprisonment too harsh or biased? I mean, yes, I think
Speaker 1: we can agree. Can all agree that yeah, it was?
Speaker 1: But should measures have been put into place that would
Speaker 1: have prevented her from making others sick?
Speaker 3: Yes, without a doubt. Yes.
Speaker 1: In any society, there is no such thing as absolute freedom.
Speaker 1: There is a limit. If by exerting your own individual
Speaker 1: rights you are impinging on the right or health of others,
Speaker 1: then that freedom is not something owed to you. This
Speaker 1: is part of the social contract, the agreement that we
Speaker 1: all make that by living in and benefiting from a society,
Speaker 1: we have to give up some of our individual freedoms.
Speaker 1: This can be a tough balance to strike, particularly in
Speaker 1: the realm of public health. There's a quote from one
Speaker 1: of the books I read about typhoid Mary. Quote.
Speaker 3: But first, and I just want to say, you said
Speaker 3: that really beautifully like, I absolutely loved it.
Speaker 2: I feel very strong way about this.
Speaker 3: It was I mean, I feel exactly one hundred percent
Speaker 3: exactly the same way. But the just the way that
Speaker 3: you worded that was perfect.
Speaker 2: Thank you.
Speaker 1: Okay, here's the quote. Yeah, on the one hand is
Speaker 1: the commitment to protect the public's health. On the other
Speaker 1: is the fear of arbitrary power and the loss of
Speaker 1: individual freedoms.
Speaker 2: That's from Judith leave.
Speaker 1: It, mandatory vaccinations, forced quarantines, public identification of so called
Speaker 1: patient zeros, and in the context of COVID nineteen mask mandates.
Speaker 1: These are all areas in which there has been ample
Speaker 1: discussion of individual freedoms being trampled upon, some of which
Speaker 1: may be justified, others definitely not. Like masks, let's not
Speaker 1: mistake inconvenience for oppression a whole snap, being imprisoned on
Speaker 1: an island for decades because you are an asymptomatic carrier
Speaker 1: of typhoid. Yeah, okay, maybe there's a touch of oppression there,
Speaker 1: having to wear a mask to pop into the grocery
Speaker 1: store for fifteen minutes. That's not oppression, not your impression,
Speaker 1: end of story, not oppression.
Speaker 2: It's not oppression.
Speaker 1: So what can we learn from Mary Mallin's experience?
Speaker 3: Oh good question.
Speaker 1: As I was reading about the story of Mary Mallin,
Speaker 1: one thing that stuck out to me was how much
Speaker 1: pain and suffering, both for Mary and for the people
Speaker 1: that she infected, could have been prevented through simple communication. Yeah,
Speaker 1: her doctor's the New York City Health Department. They could
Speaker 1: have taken the time to talk with her, not down
Speaker 1: to her, about the science behind typhoid fever transmission, and
Speaker 1: they could have explained in a non judgmental way, how
Speaker 1: she could transmit on inten intentionally the bacterium to those
Speaker 1: around her. And then maybe they could have given her
Speaker 1: more opportunities or training to find employment in.
Speaker 2: A different area.
Speaker 1: Maybe then she wouldn't have felt like she needed to
Speaker 1: lie to continue to cook. Yeah, We as a society
Speaker 1: have the knowledge and the platforms to communicate accurate scientific information,
Speaker 1: and when that information has the power to save people's
Speaker 1: lives and prevent misery and suffering, leaders have a responsibility
Speaker 1: to communicate that information without their own political agenda and accurately. YEP.
Speaker 1: The disinformation and mistrust in science spread by Donald Trump
Speaker 1: and other members of the Republican Party during this pandemic
Speaker 1: and other world leaders I should know, Like, yep, you
Speaker 1: know Alonaro is not.
Speaker 3: You know, Boris Johnson. It's fine. I was a nice
Speaker 3: to you. Now I'm fine.
Speaker 1: This has already done incalculable damage.
Speaker 2: How many deaths?
Speaker 1: How much misery? How much suffering could have been prevented
Speaker 1: by communicating science rather than sowing hatred and fear. History
Speaker 1: is full of lessons like this. And you know, there's
Speaker 1: that saying that's like those who cannot learn from history
Speaker 1: are doomed to repeat it.
Speaker 2: But like, I mean, yes, that's true, but.
Speaker 1: I think what might be, you know, an addendum should
Speaker 1: be and those that do learn history are just doomed
Speaker 1: to watch others repeat it. We can always do better,
Speaker 1: but it feels like we rarely actually do well.
Speaker 3: It also might be that people are taking the wrong
Speaker 3: lessons from history or learning the wrong parts of history.
Speaker 2: That's definitely true.
Speaker 3: We did a great job. We isolated Mary on an
Speaker 3: island and kept her there forever, Like, you.
Speaker 1: Know, it's a much more nuanced story than that they
Speaker 1: are the nuance. I feel like that's important, Like, yes
Speaker 1: it was unfair, but yes she.
Speaker 2: Also killed people.
Speaker 1: So what can we do differently, Like, that's what we
Speaker 1: should be asking ourselves, and we have the opportunity now,
Speaker 1: so like yeah.
Speaker 2: But yeah, I've gone on way too long already.
Speaker 1: So I'll just wrap up the history by saying that
Speaker 1: with improved sanitation and clean water infrastructure, combined with the
Speaker 1: development of chlorin fenacol in nineteen forty eight, typhoid like
Speaker 1: really dropped in the second half of the twentieth century
Speaker 1: in most developed countries. However, however, it has continued to
Speaker 1: cause enormous outbreaks, which some of these outbreaks leading to
Speaker 1: over one hundred thousand deaths in many other parts of
Speaker 1: the world, and the emergence of drug resistance strains might
Speaker 1: pose an additional threat. But Erin, I'm gonna let you
Speaker 1: take it from here.
Speaker 3: Oh great, love to pick it up on such a
Speaker 3: happy note.
Speaker 1: Oh boy, I'm sorry, I'm sorry.
Speaker 3: Let's take a quick break before we jump in. So
Speaker 3: I already said this, but I'll just repeat it. We
Speaker 3: do not have good data on the incidence of typhoid
Speaker 3: fever globally. There's really big ranges. One of the biggest
Speaker 3: papers that estimated typhoid disease burden was all the way
Speaker 3: back in two thousand and four, and that estimated over
Speaker 3: twenty one million cases annually. And that one also estimated
Speaker 3: an overall fatality rate of about one percent, which would
Speaker 3: mean over two hundred thousand deaths annually globally. Oh my,
Speaker 3: so that was a two thousand and four estimate. Another
Speaker 3: paper from twenty twelve estimated thirteen and a half million
Speaker 3: cases annually. So if you look at the World Health Organization,
Speaker 3: they say somewhere between eleven to twenty one million people
Speaker 3: becoming sick with typhoid fever every year worldwide, and they
Speaker 3: estimate between one hundred and twenty eight and one hundred
Speaker 3: and sixty one thousand people dying every year.
Speaker 2: Wow wan.
Speaker 3: I yeah, if that's not depressing enough, Okay, here we go.
Speaker 3: Like I mentioned earlier, typhoid is largely a disease of
Speaker 3: children in places where it's endemic. So Pakistan is one
Speaker 3: place that I'm going to talk a lot about because
Speaker 3: there's some very good things happening in Pakistan right now.
Speaker 3: But sixty three percent of cases and eighty percent of
Speaker 3: deaths related to typhoid were among children under the age
Speaker 3: of fifteen, for example. Oh my god. Yeah, So it's really,
Speaker 3: really awful in the US, just for sort of local coverage,
Speaker 3: the US estimates over five thousand, seven hundred cases of
Speaker 3: typhoid in the US every year, although we only actually
Speaker 3: diagnose about three hundred and fifty cases, which I think
Speaker 3: is really interesting.
Speaker 1: Huh.
Speaker 3: So that's like part of how we have such a
Speaker 3: huge discrepancy where we only diagnose this many and then
Speaker 3: we have to estimate that that's like less than ten
Speaker 3: percent of the total number of cases we think there
Speaker 3: actually are. Now, like you mentioned Aaron, antibiotic resistance is
Speaker 3: a massive problem for salmonilla typhee, as it is for
Speaker 3: most bacteria that we talk about. Boy, but another time,
Speaker 3: I'll talk about Pakistan, another depressing one before we get
Speaker 3: to the good news. Since twenty sixteen, Pakistan has been
Speaker 3: in the midst of an extensively drug resistant typhoid epidemic
Speaker 3: since twenty sixteen. Between twenty sixteen and twenty nineteen, over
Speaker 3: ten thousand people had been infected with a strain that
Speaker 3: is resistant to all but one oral antibiotic.
Speaker 2: Oh my gosh.
Speaker 3: And it's not just there, I mean, typhoid is a
Speaker 3: global disease. It's in I think basically every country, right,
Speaker 3: like it's across the whole globe, and antibiotic resistance has
Speaker 3: been documented across the globe. So let's end with some
Speaker 3: slightly good news, shall we.
Speaker 2: That sounds great.
Speaker 3: In twenty seventeen, the World Health Organization prequalified a new vaccine.
Speaker 3: And this is an exciting one if you remember from
Speaker 3: our vaccines episode, which if you want to go back
Speaker 3: and listen, and you can do that, but I'm going
Speaker 3: to explain it anyways, so you don't have to. There's
Speaker 3: a bunch of different types of vaccines. And I mentioned
Speaker 3: that the vaccines that we already have for typhoid are
Speaker 3: a polysaccharide, which is just a sugar, or we have
Speaker 3: a live attenuated vaccine, but you can't give that to
Speaker 3: small children. So a better type of vaccine would be
Speaker 3: a conjugate vaccine, which is when you take a polysaccharide
Speaker 3: which is a sugar, and you link it to a
Speaker 3: peptide or a protein, because the proteins are what actually
Speaker 3: allow for our body to make a stronger and more
Speaker 3: long lasting immune response. So in twenty seventeen, the World
Speaker 3: Health Organization prequalified a conjugate vaccine.
Speaker 2: That's very exciting.
Speaker 3: It's very exciting. Yes, it is, and so it's a
Speaker 3: very promising vaccine that was just a prequalification. Recent data
Speaker 3: from a phase three clinical trial that's going on in
Speaker 3: Nepal shows that it's very effective at inducing an immune
Speaker 3: response and it reduced Salmonella typhee infection across the study period.
Speaker 3: And this study was done in children aged nine months
Speaker 3: to sixteen years, So that means this is a vaccine
Speaker 3: that will be able to be given to children. It's
Speaker 3: already being given to children and it's effective.
Speaker 2: That's amazing.
Speaker 3: Yes, Now, even though this is a vaccine that's still
Speaker 3: undergoing investigation, so we're still in like the last phase
Speaker 3: of trials. Typhoid is such a huge problem, and especially
Speaker 3: these antibiotic resistance strains. There's been enough studies of the
Speaker 3: safety of this vaccine that starting in twenty nineteen, this
Speaker 3: vaccine has been introduced into routine immunization in some countries,
Speaker 3: including Pakistan. This is like what's ongoing right now is
Speaker 3: that kids now are like starting are getting this vaccine.
Speaker 3: So hopefully, yeah, in the next year, two years, three years,
Speaker 3: we should really see a drop in typhoid. That's awesome,
Speaker 3: isn't it. It's really like that's incredible to finally have
Speaker 3: a vaccine that's long lasting, that's effective, and that can
Speaker 3: be given to children so that we can really protect
Speaker 3: the most vulnerable groups. Like that's incredible, especially as it
Speaker 3: becomes more widely available. That's my good news thereon Oh good,
Speaker 3: I loved it. So that's I think the story of typhoid.
Speaker 2: It's a long story, pretty.
Speaker 3: Long, not our longest, not our longest. A good start
Speaker 3: to this season, though, I think it feels good.
Speaker 2: It feels yeah, I am.
Speaker 1: I'm looking forward to all of the diseases that we're
Speaker 1: going to be covering this season. We have a few
Speaker 1: fun ones lined up already, including spoilers, a crossover.
Speaker 3: So the crossover is going to be good. I am
Speaker 3: very excited about it. So normally last season, when we
Speaker 3: did our COVID episodes, those were entirely separate. We talked
Speaker 3: a little bit about it today because you can't not, right, Yeah,
Speaker 3: not when you're talking about typhoid.
Speaker 1: Marry you know, right.
Speaker 3: But from this point forward, we will, as last season,
Speaker 3: have our COVID episodes be separate from our regular episodes,
Speaker 3: so there won't be a ton of COVID talk in
Speaker 3: our normal episodes. If you're like, don't want to listen
Speaker 3: to it or whatever?
Speaker 2: Right, Yeah, so, but.
Speaker 3: Yeah, it's this wasn't this was a very important episode
Speaker 3: I think to do in this climate.
Speaker 2: Yeh oh boy? Well yeah, sources.
Speaker 1: Okay, I've got a few books that can shout out.
Speaker 1: So one by Adler and Mara called Typhoid Fever, a
Speaker 1: History Judith Leavett who wrote Typhoid Fever Captive to the
Speaker 1: Public's Health. And also did you know that Anthony Bourdain
Speaker 1: wrote a book about typhoid Mary?
Speaker 3: Stop Anthony Boardin like Anthony Bourdain?
Speaker 2: Yeah what?
Speaker 4: Yeah?
Speaker 1: Did I read that one too, because she was a cook. Okay,
Speaker 1: there's an interesting one. And then I will shout out
Speaker 1: a few papers that were super helpful. So there was
Speaker 1: a couple of papers by VJ. Cirillo that were actually
Speaker 1: like really interesting, and then also by Priscilla Wold Typhoid
Speaker 1: Mary and the Science of Social Control. I have actually
Speaker 1: like a lot of different papers for this one, so
Speaker 1: just check it out on our website.
Speaker 2: I don't want to spend the next five minutes reading them.
Speaker 3: I had a few different papers on the kind of
Speaker 3: meganisms of typhoid and the clinical disease if you want
Speaker 3: to know more about the carrier state. That paper is
Speaker 3: by Gonzalez Escobato at All in Nature Reviews Microbiology, and
Speaker 3: then the papers and information about the new vaccine. All
Speaker 3: of that will be on our website this podcast will
Speaker 3: Kill You dot Com under the episodes tab where you
Speaker 3: can find the sources for this episode and every episode
Speaker 3: we've ever done. Sixty one.
Speaker 1: This is number sixty one, sixty one Wow, of our
Speaker 1: normal season episodes. Yes, we've done more COVID but yeah, well.
Speaker 1: Thank you to Bloodmobile for providing the music for this
Speaker 1: episode and all of our episodes.
Speaker 3: Big time shout out to Georgia Hartstark for introducing us
Speaker 3: with typhoid so many years ago.
Speaker 1: Yes, thank you to also everyone at the exactly right
Speaker 1: network to make this podcast possible.
Speaker 3: Definitely big time. Thank you, thank you, and thank you.
Speaker 2: Thank you to you listeners for listening. It's honestly like,
Speaker 2: we're honored.
Speaker 1: We can't believe people want to listen.
Speaker 3: But a literal dream, a literal dream that we didn't
Speaker 3: even know that we had, and now we can't stop
Speaker 3: dreaming it, and it's the greatest.
Speaker 1: It's basically what it feels like. Well, until next time,
Speaker 1: wash your hands, you.
Speaker 3: Felt the animals, and literally just wear a mask.
Speaker 1: Please wear a mask.