Speaker 1: July twenty ninth, eighteen forty seven. The mate continued to
Speaker 1: grow worse, and the mistress was unceasing in her attention
Speaker 1: to him. The day was exceedingly hot and sultry, and
Speaker 1: I could not have remained on deck, but the captain
Speaker 1: spread an awning over it, which kept the cabin cool.
Speaker 1: We lay at some distance from the island, the distant
Speaker 1: view of which was exceedingly beautiful. At the far end
Speaker 1: were rows of white tents and marquees, resembling the encampment
Speaker 1: of an army. Somewhat nearer was the little fort and
Speaker 1: residence of the Superintendent Physician, and nearer still the chapel
Speaker 1: Siemen's Hospital and little village, with its wharf and a
Speaker 1: few sailboats, the most adjacent extremity being rugged rocks, among
Speaker 1: which grew beautiful fir trees at high water. This portion
Speaker 1: was detached from the main island and formed a most
Speaker 1: picturesque islet. But this scene of natural beauty was sadly
Speaker 1: deformed by the dismal display of human suffering that it presented.
Speaker 1: Helpless creatures being carried by sailors over the rocks on
Speaker 1: their way to the hospital. Boats arriving with patients, some
Speaker 1: of whom died in their transmission from their ships. Another,
Speaker 1: and still more awful sight, was a continuous line of boats,
Speaker 1: each carrying its freight of dead to the burial ground
Speaker 1: and forming an endless funeral procession. Some had several corpses
Speaker 1: so tied up in canvas that the stiff, sharp outline
Speaker 1: of death was easily traceable. Others had rude coffins constructed
Speaker 1: by the sailors from the boards of their berths or
Speaker 1: should I say cribs. In a few a solitary mourner
Speaker 1: attended the remains, but the majority contained no living beings
Speaker 1: save the rowers. I could not remove my eyes until
Speaker 1: boat after boat was hid by the projecting point of
Speaker 1: the island, round which they steered their bloomy way. From
Speaker 1: one ship. A boat proceeded four times during the day,
Speaker 1: each time laden with a cargo of day. I ventured
Speaker 1: to count the number of boats that passed, but had
Speaker 1: to give up the sickening task. Oh my goodness. Yeah.
Speaker 1: So that is from a diary that somebody published called
Speaker 1: Famine Ship Diary The Journey of a Coffin Ship, and
Speaker 1: it's written by someone named Robert White, but that's a pseudonym,
Speaker 1: and it tells the story of gross Isle, which is
Speaker 1: a place in Canada where a lot of ships sailed
Speaker 1: to from Ireland during the famine and Typhus was absolutely
Speaker 1: out of control in Ireland on the ships, and it's
Speaker 1: estimated that more than twenty thousand people died from eighteen
Speaker 1: forty seven to eighteen forty eight on these so called
Speaker 1: Coffin ships and also in Canada when they landed. And
Speaker 1: a lot of people who died were mostly people coming
Speaker 1: from Ireland, but also like the doctors and the priests
Speaker 1: and clergymen or someone who attended attended them. So yeah,
Speaker 1: it's really by heartbreaking. God, that's awful. Erin Yeah. Hi,
Speaker 1: I'm Aaron Welsh and I'm Erin alman Updyke and this
Speaker 1: is this podcast will kill you. Welcome.
Speaker 2: We're starting strong clearly to our fifth season.
Speaker 1: Yeah. This is episode eighty six of Yeah, which marks
Speaker 1: the beginning of our fifth season. Feels like it was
Speaker 1: just yesterday that we recorded alcohol it was it kind
Speaker 1: of was kind of was, But we're excited to be
Speaker 1: back and we're excited to do this episode. This topic,
Speaker 1: I mean, this is a this is a big one.
Speaker 1: It almost rightly belongs in Like our first season.
Speaker 2: I think it was a strong first season contender, and
Speaker 2: it's just taken us four extra seasons to get here.
Speaker 1: It's gonna be a very interesting episode, I think. I
Speaker 1: think so too. I gained a new appreciation for lice.
Speaker 2: I can't wait to talk about lice in like more
Speaker 2: detail than people want.
Speaker 1: I know, lifes are so fascinating. I think this just
Speaker 1: like goes to show that we got our PhDs in
Speaker 1: the right field. I was thinking the same thing. We
Speaker 1: are true vector borne disease ecologists of heart, I think
Speaker 1: really are. Yeah, Okay, so Aaron, Yes, what time is it?
Speaker 2: It is quarantiney time it is?
Speaker 1: And what are we drinking this week?
Speaker 2: This week we're drinking the sous Laus.
Speaker 1: The saust Laus. I love it. And in the South,
Speaker 1: louse is basically it's like a you know, a bourbon eggnog. Yeah,
Speaker 1: you can do rum if you want. I'm gonna do bourbon.
Speaker 1: And I've never made eggnog before in my life, like
Speaker 1: I've only ever just gotten it from the store. But
Speaker 1: I made it for the first time and it is
Speaker 1: really delicious, Like.
Speaker 2: I've never had eggnog that I've enjoyed, so I would
Speaker 2: like to try your eggnog please.
Speaker 1: Okay, but yeah, part of the reason that I wanted
Speaker 1: to do an eggnog for this is because Harold Cox
Speaker 1: I think was his name, was a researcher at Rocky
Speaker 1: Mountain Labs in Hamilton, Montana, which we talked about in
Speaker 1: our Rocky Mountain Spot a Fever episode, and he developed
Speaker 1: a typhus vaccine in egg yolks, and so I thought,
Speaker 1: you know what, let's do an eggnog. And also, like,
Speaker 1: this episode's supposed to come out December, so perfect feels
Speaker 1: like a good seasonal BEV.
Speaker 2: So we'll post the full recipe for that quarantini as
Speaker 2: well as the non alcoholic version r plasy Brita on
Speaker 2: our website. This podcast will kill you dot Com and
Speaker 2: all of our social media channels.
Speaker 1: We will. And I just want to add that don't
Speaker 1: feel compelled to homemake eggnog like and you know, there
Speaker 1: are tons of options out there at the store, and
Speaker 1: there are tons of non dairy options and vegan options
Speaker 1: as well, so take your pick. Really it works with
Speaker 1: eggish nug Yeah, eggish noob Okay, other podcast business.
Speaker 2: As always, this podcast will kill you. Dot com is
Speaker 2: our website and it's pretty great.
Speaker 1: You should check it out.
Speaker 2: We have links to our Goodreads list and our bookshop
Speaker 2: dot org affiliate account. We have links to plodmobile, our
Speaker 2: music who's also on Spotify. We've got links to our Patreon.
Speaker 2: We've got merch, so much cool merch. Did you get
Speaker 2: your holiday gifts yet?
Speaker 1: Aaron, What am I missing? I honestly, I don't know.
Speaker 1: I'm just glad that you went through so many of
Speaker 1: them that I wasn't even I was like, she's got it,
Speaker 1: She's got it covered totally. Oh transcripts. Transcripts. Yeah, see,
Speaker 1: I wasn't even. I don't want to say I wasn't
Speaker 1: paying attention, but I just had full confidence that you
Speaker 1: have a thinks I appreciate that. So before we begin,
Speaker 1: I just want to thank everyone who suggested topics to
Speaker 1: cover for this season, Like we got so many amazing requests,
Speaker 1: so I think that we can essentially keep doing this
Speaker 1: podcast until the end of time because literally like hundreds
Speaker 1: and hundreds of suggestions so.
Speaker 2: Yes and really good ones, really good ones, and we
Speaker 2: also heard from listeners who really wanted to hear more.
Speaker 2: In our diabetes episode about obesity and fat phobia, and
Speaker 2: in our alcohol episode, people wanted to hear more about addiction,
Speaker 2: and both of those are huge topics that we're hoping
Speaker 2: to tackle in future episodes.
Speaker 1: Yeah. Absolutely, we wanted to give them the time that
Speaker 1: they deserve and so like devote entire episode or episodes
Speaker 1: to those.
Speaker 2: So yeah, exactly and ear out.
Speaker 1: Okay with that? Should we should we do it? I
Speaker 1: think it's yeah, I think we should. Let's take a
Speaker 1: quick break and then tell me all about typhus.
Speaker 2: So if you just hear the word typhus listeners, not
Speaker 2: Aaron who just researched typhus for a long time, you
Speaker 2: might think one of a few different things. You might
Speaker 2: actually think of typhoid, which I.
Speaker 1: Know I keep. There were a few times when I
Speaker 1: had to correct in my notes that said typhoid, and
Speaker 1: I'm like, why am I doing this?
Speaker 2: Yeah, we covered typhoid in the season opener of our
Speaker 2: last season, and this isn't that so typhoid and typhus
Speaker 2: are two different.
Speaker 1: Groups of fevers. But then even if.
Speaker 2: You are thinking about typhus, there's at least three different
Speaker 2: diseases that are called typhus. There's mirroring scrub and epidemic varieties,
Speaker 2: and they all have additional names just to really keep
Speaker 2: things interesting in this episode today we are not going
Speaker 2: to cover all of these forms of typhus. But although
Speaker 2: we're only focusing on one of these Typhus fevers, the
Speaker 2: truth is that by the end of this episode you
Speaker 2: will actually know kind of a lot about all of
Speaker 2: the different kinds of Typhus fevers, just because while these
Speaker 2: three diseases differ both in terms of their causative agents
Speaker 2: and their transmission routes and their ecology and epidemiology, they're
Speaker 2: quite different, but in terms of the actual disease or
Speaker 2: illness that they cause, they're not all that different.
Speaker 1: That's really interesting, like convergent disease characteristics.
Speaker 2: Well, the truth is they're just caused by really similar pathogens.
Speaker 1: So let's get into it briefly.
Speaker 2: I'll quickly mentioned the other two and then we'll get
Speaker 2: into the meat of the episode, which is epidemic typhus.
Speaker 2: So first, there's scrub typhus, which is also called bush typhus.
Speaker 2: Both of those are not great names, but they're caused
Speaker 2: by a bacterium known as Orientia sutsugum mushi and I
Speaker 2: might have pronounced that horribly. But this form of typhus
Speaker 2: is transmitted by the bites of infected mites laurevil mites,
Speaker 2: which you may know of as triggers.
Speaker 1: Uh huh.
Speaker 2: Very familiar, very very too familiar with them.
Speaker 1: Yeah, intimately familiar from thanks to yeah, Kentucky and Panama
Speaker 1: and sitting in the grass when I should not have.
Speaker 2: Never sit in the grass. So that's scrub typhus. There's
Speaker 2: also mirroringe typhus, which is also called fleaborne typhus or
Speaker 2: very confusingly endemic typhus.
Speaker 1: Very confusingly indeed.
Speaker 2: So this is a disease caused by Ricketsia typhee, which
Speaker 2: is also confusing because typhee And anyways, yeah, it's caused
Speaker 2: by a bacterium called Ricketzia typhee.
Speaker 1: And this form of typhus is.
Speaker 2: Transmitted by the feces of fleas aka flea dirt, as
Speaker 2: we learned in our Bartonella episode. And then there is
Speaker 2: epidemic typhus, and epidemic typhus is what we're going to
Speaker 2: focus on today. Epidemic typhus is also aka lousbourne typhus,
Speaker 2: and this form is caused by the bacterium Ricketzia prow azechii.
Speaker 2: So this typhus Ricketzia prow ezechii is transmitted by the
Speaker 2: poop the feces.
Speaker 1: Also, is it.
Speaker 2: Also called dirt I'm not sure of lice. And we're
Speaker 2: going to get into more detail, like deep detail about
Speaker 2: that transmission cycle in just a second, but just to
Speaker 2: kind of up these other typhee fevers, So scrub typhus
Speaker 2: andmurine typhus are similar diseases, and in truth, the pathogens
Speaker 2: are very similar. So murine typhus is also caused by
Speaker 2: a Ricketsia and often you see meurine or endemic typhus
Speaker 2: and epidemic typhus grouped together into what are called typhus
Speaker 2: group ricketzioses. So these are very similar diseases. Endemic or
Speaker 2: murine typhus tends to be a less severe disease for
Speaker 2: the most part.
Speaker 1: And is Ourentia is that a group that's closely related
Speaker 1: to Ricketzia. Okass that I was just gonna say.
Speaker 2: Yeah, So scrub typhus caused by an Orentia bacterium is
Speaker 2: in the same family of Ricketsia, So it's a different
Speaker 2: genus but very similar in.
Speaker 1: Truth, like intracellular super reduced genome. Okay, exactly, Yeah.
Speaker 2: I think it's a little bit larger of a genome
Speaker 2: than a Ricketsia, but it's still it's an intracellular and
Speaker 2: the disease looks very similar can also be very severe.
Speaker 2: But historically, as you'll get into aarin epidemic, Typhus has
Speaker 2: caused the most severe and widespread disease worldwide.
Speaker 1: Way more than I had even thought before. Exactly.
Speaker 2: Yeah, yeah, So that's what we're going to focus on today.
Speaker 2: Ricketsia prow a zechii, like I said, transmitted by the
Speaker 2: feces of the human body louse pendiculous Humanis corporus, one
Speaker 2: of our old friends from Bartonella, right, m h. And
Speaker 2: I'm going to go into more detail about the human
Speaker 2: body louse, and I know you are to erin.
Speaker 1: I'm excited me too.
Speaker 2: It's so interesting as a vector for a few reasons.
Speaker 2: And I don't think we really got into this in
Speaker 2: Bartnella because we were covering so much ground, but I
Speaker 2: know that we did talk in our Bartnella episode about
Speaker 2: just how host specific insect is lice are so specific
Speaker 2: to their individual host species that the human body louse
Speaker 2: is a separate louse than the human head louse like asterisk.
Speaker 2: Oh oh, well, separate subspecies asterisk. Oh okay, Oh my gosh,
Speaker 2: you're killing.
Speaker 1: Me here, I'm sorry.
Speaker 2: All right, Well, anyways, historically they have been which is intense. Yeah,
Speaker 2: and part of this intensity lies in the fact that
Speaker 2: lice are really very fragile creatures, so they can live
Speaker 2: up to four to twelve weeks. And body lice generally
Speaker 2: live in and on our clothing for the entirety of
Speaker 2: their life cycle. But they're incredibly sensitive to temperature and humidity.
Speaker 2: So if their host I e. Us humans, for example,
Speaker 2: comes down with a fever, lice will flee their hosts.
Speaker 1: So I have a quote about lice fleeing their hosts.
Speaker 1: When Thomas Beckett died in the twelfth century and his
Speaker 1: body was laid out for the public funeral, onlookers noted
Speaker 1: that as his body cooled, the lice living in his
Speaker 1: clothes began to crawl out and quote boiled over like
Speaker 1: water in a simmering cauldron. And the onlookers burst into
Speaker 1: alternate weeping and laughter.
Speaker 2: Oh no, no, no, no, no, that's a.
Speaker 1: Lot of lice. That's a lot of lice.
Speaker 2: Okay, Well, with that lovely image in mind. Lice are
Speaker 2: also very susceptible to dehydration, so in addition to human
Speaker 2: body temperature, humidity is really important. So they're poop, which
Speaker 2: again is what contains the infectious bacteria, is really really
Speaker 2: dry and powdery, which is an image that I never
Speaker 2: had thought of.
Speaker 1: Mm hmm.
Speaker 2: But their poop is only like two percent water.
Speaker 1: Wow, uh huh. They're very efficient extrac creatures.
Speaker 2: I looked it up for reference, and our body poop
Speaker 2: is like seventy five percent water.
Speaker 1: Okay, come on, we gotta do better than that. Although
Speaker 1: pretty good.
Speaker 2: Yeah, Anyways, that's a long divergence. But all of that
Speaker 2: is to say that lice living in and on our
Speaker 2: clothes they have to blood feed all the day time,
Speaker 2: like five times a day every day for weeks on end,
Speaker 2: and while they're doing that in our bloodstream, they pick
Speaker 2: up these ricketsia. Now, then what happens is that these
Speaker 2: bacteria can infect the louse gut lining the cells that
Speaker 2: line the lice's gut their epithelial cells directly, they replicate
Speaker 2: in the gut cells of the lice, and then they
Speaker 2: burst out of those cells, which is how the bacteria
Speaker 2: gets into the feces and then is transmitted to us
Speaker 2: when we scratch that dry, flaky poop into all of
Speaker 2: our bite wounds or rub it into our eyes or nose,
Speaker 2: et cetera. However, this whole bursting out of the epithelial
Speaker 2: cells thing also goes the other way in the louse,
Speaker 2: causing blood like our human blood that they just sucked
Speaker 2: up to enter the body cavity of the lice because
Speaker 2: the Racketzia just burst open their fragile, tiny gut. The
Speaker 2: lice that are infected then become visibly red because they're
Speaker 2: full of blood that's no longer in their guts, it's
Speaker 2: just in their body cavity, and they die within a
Speaker 2: week of infection. I have no idea that this disease
Speaker 2: kills the vectors that it uses to maintain its life cycle.
Speaker 1: It's really interesting, and I have included a very touching
Speaker 1: quote about the poor louse and it's unfortunate journey when
Speaker 1: it encounters Typhos specterium.
Speaker 2: That's exactly how I felt.
Speaker 1: I was like this, poor lao, yeah, yeahhh, I think
Speaker 1: you'll really like it. I'm saving it for later, but
Speaker 1: I can't.
Speaker 2: Wait for it. But also spoilers keep that whole, like
Speaker 2: infecting the lining of something and then bursting out that thing.
Speaker 2: In mind, that's a spoiler for human disease.
Speaker 1: Too, And so for humans, in order to get infected,
Speaker 1: it really just has to be like you said, you
Speaker 1: can either rub it in a cut or stick it
Speaker 1: up your nose or in your eye. So it really
Speaker 1: is like pretty infectious in that way. Yes it is.
Speaker 2: And this is a disease that thrives when humans are
Speaker 2: in very close contact, sharing their clothing or having close
Speaker 2: bodily contact in short enough timeframes that either these lice
Speaker 2: or their poop can then be transmitted person to person
Speaker 2: and complete the life cycle. Right, okay, but yes, so
Speaker 2: it also even if the lice dies, all of that,
Speaker 2: like fluid from that dead louse is infectious as well.
Speaker 2: So scratching like the lice bodies themselves into your body
Speaker 2: can can cause infection.
Speaker 1: And do we know anything about the infectious dose? You know,
Speaker 1: I don't.
Speaker 2: I didn't see that anywhere. There's a few things that
Speaker 2: I just simply did not find.
Speaker 1: We'll get to them. That was one of them. But
Speaker 1: once we.
Speaker 2: Humans are infected, the incubation period, so the time from
Speaker 2: that infection to when we show symptoms is usually ten
Speaker 2: to fourteen days, which is actually kind of a long time.
Speaker 2: And then after that, symptoms generally start with like one
Speaker 2: to three days of just feeling cruddy, like nonspecific malaise,
Speaker 2: just feeling bad before the more kind of typical symptoms,
Speaker 2: which start with a fever a fever. Of course this
Speaker 2: podcast will kill you.
Speaker 1: He's an opener. AKA, it started with a fever.
Speaker 2: And this fever usually persists throughout the course of illness
Speaker 2: until a person I dies or recovers. So it's not
Speaker 2: like a fluctuating fever. It's just you have a fever
Speaker 2: and it's going to stay like that.
Speaker 1: And is it a high fever or is it a
Speaker 1: mild fever like it really depends.
Speaker 2: It really depends. Yeah, it kind of varies.
Speaker 1: And so does that suggest that the ricketsier replicate better
Speaker 1: at fever temperatures or is it a defense or do
Speaker 1: we know?
Speaker 2: Very good question that I don't know that I don't
Speaker 2: know the answer to.
Speaker 1: What a good question, thank you.
Speaker 2: But in addition to fever, there's also usually a pretty
Speaker 2: sudden onset of a very severe headache, and it's also
Speaker 2: common to have like abdominal pain. But otherwise, other than
Speaker 2: those things, symptoms are very nonspecific. Everything from myalgias which
Speaker 2: are muscle aches, are thralgias, which are joint pain. Maybe
Speaker 2: you'll have some chills because you have this fever, maybe
Speaker 2: anorexia or lack of hunger, not eating anything because you're
Speaker 2: just feeling really bad. If it's left untreated, about eighty
Speaker 2: percent of people will go on to have central nervous
Speaker 2: system involvement, which can be very severe. It can be
Speaker 2: delirium or seizures or coma, which can lead to death,
Speaker 2: and very commonly rashes are apparent. But the thing about
Speaker 2: these rashes is it's not like a single rash, you know,
Speaker 2: like with lime disease. It's like, oh, the classic bulls eye,
Speaker 2: It's nothing like that. In some people, they'll have these
Speaker 2: like red splotchy patches interspersed with areas that if you
Speaker 2: press on them, they'll blanch, which makes they'll like you know,
Speaker 2: go to white. But then it also can either progress
Speaker 2: to or just start out as these like smaller red
Speaker 2: spots that don't blanch when you press on them, or
Speaker 2: you can have petikia, which are like pinpoint red to
Speaker 2: purple little spots all over, like teeny tiny little dots
Speaker 2: all the way up to like larger purplish splotches.
Speaker 1: Huh okay. And it is that like a stage of
Speaker 1: the disease type of thing or is it just okay?
Speaker 1: Not from what I can tell.
Speaker 2: And what's interesting is that if you look at older studies,
Speaker 2: older studies of typhus will say like one hundred percent
Speaker 2: of people or like a very high percentage of people
Speaker 2: all have some kind of rash at some point, but
Speaker 2: some reports, more recent reports, say only twenty to forty
Speaker 2: percent of people have a rash. Unsurprisingly, it's likely because,
Speaker 2: especially more recent studies that have come out of Africa,
Speaker 2: rashes in darker skin and we've talked about this a
Speaker 2: lot on this podcast are either not present, or not
Speaker 2: apparent or not appropriately identified, and so a lot of
Speaker 2: these studies, especially out of Africa, have been ones that
Speaker 2: have reported a lot lower incidents of these rashes associated
Speaker 2: with epidemic typhus. And like even the things like whether
Speaker 2: something blanches turns back to white, like that's the definitions
Speaker 2: that we use, and that's not going to happen in
Speaker 2: the same way on darker skin as it does on
Speaker 2: lighter skin. So that's the rash, which isn't specific to
Speaker 2: begin with, but that's generally the course of epidemic typhus. Now, overall,
Speaker 2: pre antibiotics, like before we had any kind of treatment,
Speaker 2: mortality rates were estimated to be as high as like
Speaker 2: sixty percent, which is very very high.
Speaker 1: That's ridiculously high.
Speaker 2: Now with antibiotics, they are estimated to be as low
Speaker 2: as four percent, which is still very high.
Speaker 1: It's still very high.
Speaker 2: And the reason that epidemic typhus leads to death, or
Speaker 2: the way that it tends to lead to death, can
Speaker 2: be in a few different ways. One it can be
Speaker 2: because of shock, and we'll talk about that a little
Speaker 2: more in just a second. The the other thing is from
Speaker 2: these neurologic manifestations which can lead to coma and lead
Speaker 2: to death. And overall, the biggest risk factors that lead
Speaker 2: to like who is more likely to die versus survive
Speaker 2: and epidemic typhus infection are two biggest things older age
Speaker 2: and malnutrition. So poor nutritional status is very strongly associated
Speaker 2: with severe infection and death compared to good nutritional status. Now,
Speaker 2: before I get into the pathophysiology, because I know you
Speaker 2: have a lot of questions. I can see them on
Speaker 2: your face. I do want to say another interesting thing
Speaker 2: about epidemic typhus, and that is that it actually leads
Speaker 2: to a chronic infection that can then be reactivated many years,
Speaker 2: like up to forty years based on one source, I
Speaker 2: read forty years after initial infection. And this is not
Speaker 2: from re exposure, but just from reactivation of a latent infection.
Speaker 1: It sounds a lot like chicken pox and how chicken
Speaker 1: pox remained in small populations.
Speaker 2: Now, I was trying to get a handle on what
Speaker 2: percentage of people does this happen to. I do not know.
Speaker 1: I'll just say that.
Speaker 2: From what I can gather, though, it seems like if
Speaker 2: this disease is untreated, nearly everyone that survives the initial
Speaker 2: infection could potentially maintain a latent infection.
Speaker 1: But if you are treated with antibiotics or through vaccination
Speaker 1: or something, there is very low chance of that.
Speaker 2: Request say exactly, yeah, So if you're treated, then it
Speaker 2: should clear the infection. But if you're untreated and survive,
Speaker 2: it seems like that's the population that goes on to
Speaker 2: develop this latent infection, and then the risk factors for
Speaker 2: reactivation are kind of this things that we see for
Speaker 2: reactivation of a lot of different diseases, so like times
Speaker 2: of stress or immune compromise like another illness or cancer,
Speaker 2: or some other form of immunosuppression, or even just advancing age.
Speaker 2: So this whole chronic reactivation disease, this is called brills
Speaker 2: insert disease. It gets a whole new name, of.
Speaker 1: Course, I'll explain why.
Speaker 2: Oh great, I mean it makes sense honestly, yeah, yeah,
Speaker 2: but it generally looks very similar in terms of symptoms
Speaker 2: to initial infection, but tends to be a lot more mild,
Speaker 2: which makes sense because your body has seen it before, right, right,
Speaker 2: But we clearly have questions obviously, So let's get to
Speaker 2: my favorite part of the biology, which is like, how
Speaker 2: the heck does this happen in our bodies? Why are
Speaker 2: these things that we see? Aka the path of physiology?
Speaker 1: Yeah, I want to hear this me too. Well, I
Speaker 1: want to tell it to you.
Speaker 2: So ricketsias, I know, Aaron, you know a lot about
Speaker 2: these already, but listeners may also remember from our Rocky
Speaker 2: Mountain spoted fever episode. Ricketsias are these obligate intracellular bacteria,
Speaker 2: which means they have to enter our host cells in
Speaker 2: order to be able to replicate within our.
Speaker 1: Cells, very much like a virus in that way.
Speaker 2: Very much like a virus. So when we get infected
Speaker 2: from laos did we decide it's called lous dirt.
Speaker 1: Loves laust dust? I like it.
Speaker 2: Okay, When we get infected from laus dust, either from
Speaker 2: rubbing it into our skin or our eyes, the bacteria
Speaker 2: enter our bloodstream as well as our lymphatic system and
Speaker 2: they travel to infect our endothelial cells. All of the
Speaker 2: Rikkeetsias do this, and every listener of this podcast probably
Speaker 2: knows what endothelial cells are by now, because I feel
Speaker 2: like we talk about them all the time.
Speaker 1: But if this is your first episode, it is. If
Speaker 1: this is your first one.
Speaker 2: Endothelia cells are the cells that line our blood vessels,
Speaker 2: so they're like the inside lining of your arteries and
Speaker 2: veins and capillaries. Ricketsia praw azechii tends to infect the
Speaker 2: endothelial cells, specifically in our small capillaries.
Speaker 1: Why, you may ask, yes, on my face.
Speaker 2: I don't actually know, but I have suspicions. Okakay, these
Speaker 2: are not very mobile bacteria. They can't really move on
Speaker 2: their own. They just kind of go with the flow,
Speaker 2: and capillaries are where flow is the slowest, and the
Speaker 2: area between endothelial cells is really really small.
Speaker 1: Like our red blood cells have.
Speaker 2: To really squeeze to get through our capillaries. So I
Speaker 2: suspect that that is where they are most able to
Speaker 2: use their little adhesion proteins to just grab on to
Speaker 2: those endothelial cells and then get in.
Speaker 1: Okay.
Speaker 2: What's interesting though, is that a lot of other Ricketzia
Speaker 2: species tend to infect larger and like more medium sized vessels,
Speaker 2: and I don't know why that is, but in any case,
Speaker 2: Racketsia proozchii likes our tiny capillaries. It's found a nice
Speaker 2: little niche there. They enter our cells, and inside our
Speaker 2: cells they multiply and multiply and multiply and multiply. But
Speaker 2: they're not really mobile, so they're not doing anything inside
Speaker 2: of our cells. They're not even moving around within our cell.
Speaker 2: They're just replicating so much that eventually they fill up
Speaker 2: our cells and literally burst them open, releasing tons of
Speaker 2: new Ricketsias to go on and infect the neighboring endothelial cell,
Speaker 2: just like in the lause aaron.
Speaker 1: That I mean, that makes complete sense.
Speaker 2: So clearly this causes destruction of the linings of our
Speaker 2: capillaries and potentially other vessels, exclusively capillaries. Okay, this is
Speaker 2: going to cause leaking, so vascular permeability, and this, dear friends,
Speaker 2: is one of the hallmarks not just of this Ricketzia,
Speaker 2: but Ricketzia's in general. So it's widespread systemic inflammation and
Speaker 2: the leakage of our vessels. This is called vasculitis. So
Speaker 2: this can happen on a small scale and lead to
Speaker 2: micro hemorrhages, little tiny leaks from our tiny, little capillaries,
Speaker 2: or it can happen on a larger scale and lead
Speaker 2: to macro hemorrhages.
Speaker 1: And so is this why we see the rashes that
Speaker 1: we see.
Speaker 2: I think that's a large part of the rashes. Yes, okay, absolutely,
Speaker 2: and why they can be so variable as well. Okay,
Speaker 2: And this leaky blood and this tissue damage also stimulates
Speaker 2: a lot of inflammation, so then you have white blood
Speaker 2: cells and other inflammatory markers coming to the region. And
Speaker 2: all of this inflammation can actually stimulate thrombosis, so our
Speaker 2: body trying to clot off our blood so that we
Speaker 2: don't hemorrhage. Huh. See our hemophilia episode for more. On
Speaker 2: that process clotting cascade. But in this case, what that
Speaker 2: leads to is then these little areas of thrombus or
Speaker 2: clot in, these tiny, tiny little vessels surrounded by inflammation
Speaker 2: that then leads to cutting off of blood supply in
Speaker 2: certain areas, especially in our brain, since this is a
Speaker 2: bacteria that, by traveling through our blood vessels, is able
Speaker 2: to make its way past our blood brain barrier and
Speaker 2: infect the endothelial lining of the small vessels of our brain.
Speaker 2: Oh oh right, so it cuts off blood flow to
Speaker 2: parts of our brain.
Speaker 1: Oh that is really that's really bad, and that explains
Speaker 1: a lot, okay.
Speaker 2: And so this actually leads to a very specific finding
Speaker 2: called typhus nodules that are basically little bloods in the
Speaker 2: wall or near the wall of these small blood vessels
Speaker 2: in our nervous system that are then surrounded by a
Speaker 2: whole bunch of inflammation. And that's kind of a characteristic
Speaker 2: finding of a typhus infection in the brain, okay.
Speaker 1: And so, like you said that it because it travels
Speaker 1: in the bloodstream, it really can go anywhere in the body.
Speaker 1: And so is it just kind of like random does
Speaker 1: the inflammation ever cut off the spread of it to
Speaker 1: the brain or to other parts of the body, you
Speaker 1: know what I mean. Yeah, it's a good question.
Speaker 2: I think in general, with these kind of blood borne
Speaker 2: infections that travel in the bloodstream, they often go first
Speaker 2: to areas of really high blood flow, so places like
Speaker 2: the brain, the liver, the spleen, and you do see
Speaker 2: a lot of involvement of those areas. But I think
Speaker 2: eventually and theoretically, this can go kind of anywhere. So
Speaker 2: it also probably depends too on where the initial site
Speaker 2: of infection is and how it has to travel and
Speaker 2: like what specific root it ends up on.
Speaker 1: Yep, Okay, cool, interesting.
Speaker 2: Yeah, so that's why though mortality is often caused by
Speaker 2: both shock in this case because of the volume loss
Speaker 2: from these leaky vessels or from the nervous system damage
Speaker 2: that can lead to then coma and death.
Speaker 1: Wow. And sixty percent.
Speaker 2: Sixty percent if untreated.
Speaker 1: Yeah, it's terrifying. Wow, I mean that's horrific. Yeah. Yeah.
Speaker 2: The good news is we do have treatment, so it's
Speaker 2: a very treatable disease, and it's actually quite easy to
Speaker 2: treat with either a one time dose or a very
Speaker 2: short course of antibiotics. And from what I can tell,
Speaker 2: it still works really well. Not a ton of concern
Speaker 2: for resistance from what I could tell. But the other
Speaker 2: thing that's incredibly important, even if you're treating with antibiotics
Speaker 2: is that you have to get rid of the lice, right,
Speaker 2: So antibiotics are not enough. You also have to be
Speaker 2: able to wash clothing and hot enough water to be
Speaker 2: able to kill the lice or leave the clothing and
Speaker 2: the bedding that are infested unused for at least a
Speaker 2: week so that they all die. So that's a huge
Speaker 2: part of both the treatment and prevention of epidemic typhus.
Speaker 1: That makes sense, yeah, I mean.
Speaker 2: Oh, Also, just like as a side note, this is
Speaker 2: a human specific disease, except that there's some weird cases
Speaker 2: involving flying squirrels.
Speaker 1: Yeah, I'm gonna talk about that a little cool. I figured, yeah,
Speaker 1: and I thought I should just mention.
Speaker 2: That, like, yeah, flying squirrels are like a reservoir I know,
Speaker 2: of all of the animals. I was like, huh, I know,
Speaker 2: it's so random.
Speaker 1: It's very interesting.
Speaker 2: Yeah, but that aarin is the biology of epidemic typhus.
Speaker 1: Well do you want to hear about the history?
Speaker 2: I can't wait?
Speaker 1: Can you tell me everything? I will write after this
Speaker 1: break to set the tone for the history section. I
Speaker 1: want to start with a quote about Typhus from a
Speaker 1: book called rats Lice in History by Hans Zincer as in.
Speaker 2: Ural sincor Oh quote, soldiers have rarely won wars.
Speaker 1: They more often wipe up after the barrage of epidemics,
Speaker 1: and Typhus, with its brothers and sisters, plague, cholera, typhoid, dysentery,
Speaker 1: has decided more campaigns than Caesar, Hannibal, Napoleon, and all
Speaker 1: the inspector generals of history. The epidemics get the blame
Speaker 1: for defeat, the generals get the credit for victory. It
Speaker 1: ought to be the other way around.
Speaker 2: I love that quote, and I also love that we
Speaker 2: have now covered every one of those diseases.
Speaker 1: I know, I know. I was looking at that and
Speaker 1: I was like wow, And I was like, we could
Speaker 1: probably throw a few more in there too, to be honest, Yeah, malaria, malaria,
Speaker 1: yellow fever, I mean trench fever for that matter. Yeah,
Speaker 1: didn't really decide many wars, but we could definitely make
Speaker 1: a case for I.
Speaker 2: Think there is I think you did, I think you did.
Speaker 1: Anyways, this is this idea is a common theme for
Speaker 1: our podcast, right like, wars and unrest directly and indirectly
Speaker 1: lead to the emergence and spread of axious diseases, both
Speaker 1: among soldiers as well as civilians. You know, we've talked
Speaker 1: about dysentery loving a disaster. We've read some descriptions of
Speaker 1: the latrine conditions that led to typhoid outbreaks during the
Speaker 1: American Civil War. We've described how global movements during World
Speaker 1: War One helped spread the nineteen eighteen influenza pandemic and
Speaker 1: our very first episode, and we've even talked about the
Speaker 1: human body louse in that same war spreading trench fever,
Speaker 1: also accompanied by some very descriptive quotes of body lice
Speaker 1: and the problems with them, very descriptive. But it's taken
Speaker 1: us this long. I still can't get over it to
Speaker 1: talk about typhus, which, as you now know, with sixty
Speaker 1: percent mortality among untreated people, it ranks among you know, plague,
Speaker 1: cholera to all of those other ones in its ability
Speaker 1: to absolutely devastate a village or a city or an
Speaker 1: entire country. The historical impact of it is huge when
Speaker 1: we think about the death toll from a war or
Speaker 1: from a famine, or even from just an epidemic alone.
Speaker 1: I think that many of us probably imagine people dying,
Speaker 1: for example, in combat on D Day right, or in
Speaker 1: bombings from the Blitz, or maybe directly from starvation in
Speaker 1: the holodomor or directly from bubonic plague during the Black Death,
Speaker 1: because that's often how we learn about historical events. But
Speaker 1: even if that compartmentalization or like assigning deaths to this
Speaker 1: cause and that cause, even if that's a useful way
Speaker 1: to learn, that's not really the way it happens. Alongside
Speaker 1: death in war is death in pestilence, death in famine.
Speaker 1: I mean, this is why the four horsemen of the Apocalypse,
Speaker 1: which are most often represented as pestulence, famine, war, and death.
Speaker 1: It's why they ride together, like they don't take turns,
Speaker 1: like showing up and then like okay, peace out, it's
Speaker 1: your turn now, like it's a it's a partnership.
Speaker 2: True.
Speaker 1: The first hand account that I read described a typhus
Speaker 1: outbreak in ships of Irish immigrants fleeing during the Great
Speaker 1: Famine of around eighteen forty five to eighteen fifty two.
Speaker 1: In that famine, there were an estimated one million excess deaths,
Speaker 1: and the majority were not deaths directly from starvation, but
Speaker 1: from infectious diseases, including Typhus, And that same thing has
Speaker 1: happened time and time again in wars, where casualties from
Speaker 1: infectious disease outweigh those from battle. And I realize, like
Speaker 1: I fully realize that right now I'm presenting a microhistory
Speaker 1: of Typhus, which is like maybe a bit hypocritical about
Speaker 1: teaching things in isolation. So I really wanted to start
Speaker 1: off this section by saying that I hope you take
Speaker 1: away from this episode and appreciation for the enormous and
Speaker 1: horrible impact that type has had, and also to ask
Speaker 1: you to remember that while I'm talking about Typhus in
Speaker 1: Napoleon Soldiers or Typhus in concentration camps, Typhus was not
Speaker 1: acting alone. It worked side by side, aided and embedded
Speaker 1: with other infectious diseases as well as you know, human
Speaker 1: created miseries like war and concentration camps and famine. So
Speaker 1: now that that's out of the way, I can finally
Speaker 1: get to the meat of it by first asking not
Speaker 1: where Typhus came from, but where did lice come from? Yes,
Speaker 1: where we've already talked about how fascinating we think lis are,
Speaker 1: so it was really fun to get to read more
Speaker 1: about them for this episode. And I think I might
Speaker 1: have touched on some of this from our Bartnella episode,
Speaker 1: but I'm going to go over the basics as well
Speaker 1: as offer a self correction potential self correction. So, Rakeetzia
Speaker 1: praozekii is transmitted by the body louse, as you said,
Speaker 1: which is generally considered a different species, or at least subspecies,
Speaker 1: than the headlause. And it's been hypothesized that the body
Speaker 1: louse diverged from the head lass when a human started
Speaker 1: wearing clothing around seventy two thousand years or so, give
Speaker 1: or take, which is I think what I said also
Speaker 1: in the Bartonella episode. But after doing more lice reading
Speaker 1: for this episode, I learned that the story might be
Speaker 1: a bit more complicated. It always is, isn't it. It
Speaker 1: always is. First of all, body lice and head lice
Speaker 1: can interbreed and produce fertile offspring under experimental conditions, which
Speaker 1: is ya. That's one way that scientists often decide whether
Speaker 1: things represent different species or not, but it's not like
Speaker 1: the only criterion. Secondly, there are no consistent morphological differences
Speaker 1: between the two, and species or subspecies identification usually depends
Speaker 1: on like where on the body of the lice was found,
Speaker 1: So if it was not a head it's a head louse.
Speaker 1: If it's not on the body or in the clothing,
Speaker 1: it's a body louse. Under experimental conditions, researchers seem to
Speaker 1: have been able to raise body lice from head lice. Like,
Speaker 1: they take a population of head lice and then they
Speaker 1: raise them under bodylice conditions, and you have a what
Speaker 1: looks like a body louse. Interesting. Yeah, But there are
Speaker 1: some behavioral and physiological differences between the two, namely in
Speaker 1: that the body louse has evolved to live in clothing
Speaker 1: and lays its eggs in clothing, which head lice do
Speaker 1: not do. And there are also size differences and sometimes
Speaker 1: color differences between the two, although again those are not consistent.
Speaker 1: And until recently it was thought that body lice and
Speaker 1: head lice were indistinguishable genetically, but more recent research has
Speaker 1: led to a molecular tool that can differentiate between them. Yeah,
Speaker 1: and this finding has led to the thought that body
Speaker 1: lice and head lice aren't two different species or even subspecies.
Speaker 1: But that they represent two different ecotypes and that's the
Speaker 1: result of a difference in the way that their genes
Speaker 1: are expressed like at some point during development or growth
Speaker 1: or I don't really know about the life stage of
Speaker 1: the life stages of the lice, but fascinating. Yeah, yeah,
Speaker 1: because I was reading that they have different like feeding patterns,
Speaker 1: which they think leads to differences in vector competence. Why,
Speaker 1: Like body lice transmit a lot of things, and it's
Speaker 1: thought that head lice generally don't, even though they can,
Speaker 1: like you said in the lab. And also, like the
Speaker 1: ecotype thing, there's differences in their immune responses to infection
Speaker 1: with things, which then would make body lice more capable
Speaker 1: of getting infected with bacteria than head lice. Yeah, it's
Speaker 1: really interesting and I like, probably should do some more
Speaker 1: digging on this, But I wonder if it's just like
Speaker 1: a suite of genes that are turned on in one
Speaker 1: versus the other that has like basically over time, once
Speaker 1: humans started wearing clothing, it wasn't necessarily like a one
Speaker 1: time divergence between the two, but like a continual divergence
Speaker 1: where headlice populations, especially like an over infestation, are feeding
Speaker 1: into bodyliced populations. Like it's like, oh, I don't know
Speaker 1: what environmental cue it could be, maybe like an intense
Speaker 1: population pressure or something in a headline infestation that maybe
Speaker 1: one of them turns on those switches for the other genes.
Speaker 1: It is like, hey, I'm a body loss now I
Speaker 1: prefer a little bit cooler. I'm gonna lay my eggs
Speaker 1: out here. I'm gonna feed this way. Like it's nice
Speaker 1: to know you guys. Fascinating Aaron. Yeah, So, like it
Speaker 1: might be semantics, whether we call them subspecies or different
Speaker 1: species or ecotypes or whatever, but I just find that
Speaker 1: whole part incredibly interesting. I do too, Yeah, yeah, Okay,
Speaker 1: So all of that nitty gritty info aside. Humans have
Speaker 1: been parasitized by lice for millions of years, and that's
Speaker 1: that's very typical of lice, Like they tend to be
Speaker 1: very species specific. They're often used to track like the
Speaker 1: evolution of different mammalian species. Each species tends to have
Speaker 1: their own, you know, louse species. And because of this
Speaker 1: high degree of specialization, human lice have basically followed the
Speaker 1: distribution of their host, meaning that they are globally distributed,
Speaker 1: and they've been that way for a long time, and
Speaker 1: even though a lot of things are working against the
Speaker 1: preservation of lice in fossils, we do have some archaeological
Speaker 1: evidence to back this up. To back this like global
Speaker 1: distribution up. The oldest head louse was found on a
Speaker 1: hair from eight thousand BCE in northeastern Brazil, and the
Speaker 1: oldest found in the Old World came from roughly seven
Speaker 1: thousand BCE in Israel. Combs for head lice have been
Speaker 1: found from around sixty five hundred years ago in ancient Egypt,
Speaker 1: and lice have been found on mummies in Egypt, China,
Speaker 1: the Aleutian Islands, Greenland, and parts of South America. And
Speaker 1: I know this is like a lot about lice. So
Speaker 1: I want to read that amazing other quote that I
Speaker 1: alluded to earlier before I move on to Rikestio PRAVZAKIAI okay,
Speaker 1: so this is also from Hans Zincer. His book that
Speaker 1: rats licee in History is like a gold mine. It's
Speaker 1: a very bizarre book. I say that much. It literally was.
Speaker 1: It was like twelve chapters not about typhus or rats
Speaker 1: or lice.
Speaker 2: Oh okay, it was about history.
Speaker 1: Yeah, And like in the chapter title he would apologize
Speaker 1: for like I promise, this is the last divergence. Was
Speaker 1: It's great was written nineteen thirty five I think thirty
Speaker 1: two to thirty five, okay. Quote The louse shares with
Speaker 1: us the misfortune of being prey to the typhus virus.
Speaker 1: If lyce can dread. The nightmare of their lives is
Speaker 1: the fear of some day inhabiting an infected rat or
Speaker 1: human being. For the host may survive, but the ill
Speaker 1: starred louse that sticks his hostellum through an infected skin
Speaker 1: and imbibes the lowesome virus with his nourishment is doomed
Speaker 1: beyond sucker. In eight days, he sickens. In ten days
Speaker 1: he is in extremists. On the eleventh or twelfth day,
Speaker 1: his tiny body turns red with blood extravasated from his bowel,
Speaker 1: and he gives up His little ghost man is too
Speaker 1: prone to look upon all nature through egocentric eyes. To
Speaker 1: the loose, we are the dreaded emissaries of death. He
Speaker 1: leads a relatively harmless life, the result of centuries of adaptations.
Speaker 1: Then out of the blue, an epidemic occurs, His host sickens,
Speaker 1: and the only world he has ever known becomes pestilential
Speaker 1: and deadly, and if, as a result of circumstances not
Speaker 1: under his control, his stricken body is transferred to another host,
Speaker 1: whom he in turn infects, he does so without guile
Speaker 1: from the uncontrollable need for nourishment, with death already in
Speaker 1: his own entrails, if only for his fellowship with us
Speaker 1: in suffering, he should command a degree of sympathetic consideration.
Speaker 1: I love it. Since that's so good. I have so
Speaker 1: many quotes in this. It's just it was. I loved
Speaker 1: that so much. And gives up his tiny ghost, his
Speaker 1: tiny ghost. Can't you picture it? I can't, Oh, his
Speaker 1: little ghost. Sorry, this gives up this. It's so cute,
Speaker 1: it's so adorable. Yeah, that book definitely did convince me
Speaker 1: to like lice more as well, like appreciate their incredible
Speaker 1: biology and right and feel a little bit sympathetic. I mean,
Speaker 1: it's killing them too. Yeah. Well, anyway, let's turn to Typhus.
Speaker 1: Let's so, where did Typhus come from? Great question? We
Speaker 1: don't know what are you me or something? So from
Speaker 1: what I can tell, it's still debated whether Rakeetsia Praozekiah
Speaker 1: came from the Old World or the New World. For
Speaker 1: a lot of human history, the disease was grouped in
Speaker 1: with other fevers or not distinguished from typhoid, And like
Speaker 1: we said, that's a very common thing. The origin of
Speaker 1: the words are essentially the same. Typhoid actually comes from typhus,
Speaker 1: which comes from the Greek word typhos, meaning smoky or hazy,
Speaker 1: and that's meant to describe the neurological effects that the
Speaker 1: disease can have. And I also wanted to just because
Speaker 1: one more little thing about lice here. There are a
Speaker 1: lot of words that we use in like common English
Speaker 1: sayings that our reference to life, so like nit wit, lousy,
Speaker 1: or like a lousy night's sleep, meaning that like you
Speaker 1: were bothered by all the lice on you mm hmm,
Speaker 1: nitpicking going over something with a fine toothed comb. And chatter,
Speaker 1: which I think we mentioned in the Barnella episode, like
Speaker 1: remember to pick chats, I think, or like to chat
Speaker 1: would be to like sit there and remove lice, and
Speaker 1: so they would call it like chatter to hang out
Speaker 1: with a group of people. And I just don't remember, honestly, Yeah,
Speaker 1: there are a lot of episodes that I'm like we
Speaker 1: did that I don't remember.
Speaker 3: Doing that no recollection, Yeah, but reading back through ancient
Speaker 3: or historical writings and trying to figure out what might
Speaker 3: or might not be Typhus is super tricky, as you.
Speaker 1: Know, as you might expect, some people point towards some
Speaker 1: of Hippocrates' writings describing Typhus, or maybe the infinny in
Speaker 1: Plague in the fifth century BCE, as described by Thucydides,
Speaker 1: or maybe from a battle in Spain in ten eighty
Speaker 1: three CE, which would put the origin as old World.
Speaker 1: But those are pretty hand wavy, and a disease that
Speaker 1: sounds much more specific to Typhus doesn't show up in
Speaker 1: Europe until the very end of the fifteenth century, like
Speaker 1: as early as fourteen forty eight, I think, maybe fourteen
Speaker 1: ninety two in Granada, when seventeen thousand soldiers died of
Speaker 1: a disease that sounds a lot like Typhus. And then
Speaker 1: again this same similar disease shows up in the fifteen
Speaker 1: fifties in Spain. Quote, a new disease unknown until the
Speaker 1: time of the Civil Wars in Granada appeared in Spain
Speaker 1: in the year fifteen fifty seven and depopulated the greater
Speaker 1: part of our peninsula. It did not begin to decline
Speaker 1: until the year fifteen seventy, and around the same time
Speaker 1: or a few years before, there are descriptions of what
Speaker 1: was clearly typhus in Mexico, and the disease continued to
Speaker 1: pop up in epidemic form every time there was a
Speaker 1: drought or famine up until the nineteen hundreds. And I
Speaker 1: feel like either of those examples could be used to say,
Speaker 1: see it's clearly Old World origin, or see it's clearly
Speaker 1: New World origin. So what can the Racketzia tell us
Speaker 1: about itself? As we probably discussed in our Rocky Mountain
Speaker 1: Spotted Fever episode, the Ricketsia are these super small and
Speaker 1: bizarre bacteria. They're really closely related to mitochondria, the powerhouse
Speaker 1: of the cell, and they're very tricky to culture in
Speaker 1: a lab. And for a long time researchers were unable
Speaker 1: to find a non human reservoir for Racketzia prooz echii.
Speaker 1: But then people began finding antibodies to the Ricketzia in
Speaker 1: some domestic animals, such as like donkeys in parts of Africa,
Speaker 1: but it wasn't always consistently found, so like that didn't
Speaker 1: seem that seemed like an incidental infection like that didn't
Speaker 1: really seem like that was the source. But as you
Speaker 1: mentioned aarin, one place where it does seem to be
Speaker 1: more consistently found, and I'm talking about like antibody prevalence
Speaker 1: rates of forty percent or so is in Yeah, this
Speaker 1: the southern flying squirrel, which is found in like the
Speaker 1: eastern half of the US and down into parts of Mexico.
Speaker 2: I mean, it's just so random it.
Speaker 1: Is, and I want to know more about it. But yeah,
Speaker 1: like that right there says to me, Okay, that's a
Speaker 1: big check in the New World origin column. But I'm
Speaker 1: still not convinced because of the timing of those outbreaks.
Speaker 1: So like, did somehow it just spread in the population?
Speaker 1: Are they affected by it? Like a lot of exposures
Speaker 1: in the eastern US seemed to be associated with these
Speaker 1: Southern flying squirrel So like, yeah, what, it's just strange.
Speaker 2: It's very strange. I don't get it.
Speaker 1: I mean, but in a way, it also makes sense
Speaker 1: because like I think we talked about with the Rikkeetzia
Speaker 1: RICKETSI I also finding a non human reservoir is challenging
Speaker 1: to do. But small rodents do seem to be like
Speaker 1: very good candidates for the non human reservoir. So I
Speaker 1: don't know, but of all.
Speaker 2: The small rodents, I know, there's no like association with humans,
Speaker 2: there's no you know, I mean maybe there.
Speaker 1: Is, yeah, Like maybe there's something in the biology that
Speaker 1: somehow it just happens to work that way. Yeah, yeah,
Speaker 1: Or maybe we're just not looking enough, like you know,
Speaker 1: that's also a possibility.
Speaker 2: Definitely a possibility.
Speaker 1: So yeah, I mean, maybe we don't have a satisfactory
Speaker 1: answer right now for where exactly Rikkeetsia prawzakii came from.
Speaker 1: But it seems that once it showed up, it spread
Speaker 1: around the world pretty easily, especially under conditions like war
Speaker 1: and famine and unrest, which I mean seemed fairly consistent
Speaker 1: throughout the sixteen hundred, seventeen hundreds, eighteen hundreds, a lot
Speaker 1: of the nineteen hundreds, and wherever it originated, it would
Speaker 1: always find the vector to be able to transmit it
Speaker 1: right because body lives were already globally distributed. Analysis of
Speaker 1: dental pulp our fave from remains in a mass grave
Speaker 1: in France from a siege in seventeen ten to seventeen
Speaker 1: twelve shows evidence of Rikeetzia PRAOZEKII infection, and it was
Speaker 1: also found again in dental pulp in the remains of
Speaker 1: some of Napoleon's soldiers in a mass grave in Lithuania
Speaker 1: from the eighteen twelve campaign. It's amazing what ends up
Speaker 1: in dental pulp. They also found Bartnella, which I may
Speaker 1: have even mentioned those papers in the episode. I'm sure
Speaker 1: again I have no recollection of previous topics. But the
Speaker 1: second finding, the one of napoleon soldiers, it lends support
Speaker 1: to the idea that typhus, along with other diseases, may
Speaker 1: have been a major contributing factor to Napoleon's decision to
Speaker 1: retreat during the Russian campaign. And I don't see how
Speaker 1: he would have had any other choice, because listen to
Speaker 1: these numbers, oh dear, of Napoleon's five hundred thousand soldiers,
Speaker 1: half a million soldiers whoa that march to Moscow in
Speaker 1: eighteen twelve, three thousand returned. Yeah. Out of five hundred thousand,
Speaker 1: three thousand returned.
Speaker 2: That is incredibly depressing. U huh.
Speaker 1: And estimated twenty percent of the mortalities were due to typhus.
Speaker 2: Twenty percent due to typhus alone is typhus alone.
Speaker 1: I mean typhus aided and abetted, you know, by all
Speaker 1: these other things. But like yeh yeah, oh my so
Speaker 1: that yeah, it's it's a lot. And not long after
Speaker 1: this Napoleon's ill fated campaign to Moscow, typhus began to
Speaker 1: be distinguished as a separate disease from typhoid, although confusion
Speaker 1: seemed to linger like it had been differentiated once before,
Speaker 1: but like people were still not sure, like this this typhus,
Speaker 1: this this typhoid, it's fever. Generally it was just fever fever, yeah,
Speaker 1: But it also gained some more descriptive names, such as
Speaker 1: ship fever was a common one, jail fever, camp fever,
Speaker 1: and so on to describe the typical circumstances under which
Speaker 1: epidemics occurred. Because it's important to remember that although body
Speaker 1: life were prevalent across the globe, it's not like typhus
Speaker 1: was constantly occurring. It wasn't like a childhood illness. It
Speaker 1: wasn't like, oh, you're just going to get it, and
Speaker 1: it's it's endemic here, right. It needed a spark, which
Speaker 1: was usually provided by someone who had active typhus or
Speaker 1: who had brills in ser disease, and then it needed fuel,
Speaker 1: which was impoverished, crowded settings and malnutrition to then lead
Speaker 1: to this devastating and deadly epidemic. Even before the so
Speaker 1: called coffin ships left Ireland for North America, like in
Speaker 1: our first hand account during the Irish famine, typhus was
Speaker 1: running rampant across the country. I'm going to read another
Speaker 1: quote quote. Never had conditions been so fatally favorable to
Speaker 1: the rapid spread of lice as in the famine winter
Speaker 1: of eighteen forty six through eighteen forty seven. The people
Speaker 1: were filthy. They had sold every stitch that would fetch
Speaker 1: the fraction of a penny, and they were wearing the
Speaker 1: same rags day after day, and night and day. Their
Speaker 1: bedding had been sold, and they slept covered with rags
Speaker 1: and old coats. To heat water or wash themselves or
Speaker 1: their clothes with out of the question. They were eating
Speaker 1: their food half or holy raw because they had no
Speaker 1: money to buy fuel. Indeed, after months of starvation, even
Speaker 1: the strength to fetch water had disappeared. Once infection had
Speaker 1: been brought into a district, it spread with lightning rapidity
Speaker 1: among the crowds brought together for relief. A brush in
Speaker 1: passing was enough to transfer the fever transmitting louse or
Speaker 1: its dust like excrement to a new victim, and one
Speaker 1: fever stricken person could pass on infection to one hundred
Speaker 1: others in the course of a day. A hundred. I mean,
Speaker 1: it's easy to imagine, right, Like, yeah, it's And so
Speaker 1: that quote is from Cecil Woodham Smith who was the
Speaker 1: author of the book The Great Hunger. And in this
Speaker 1: book they estimate that about ten times as many people
Speaker 1: died of disease than of starvation during the Irish famine. Wow. Yeah,
Speaker 1: but those deaths of course probably would not have occurred,
Speaker 1: or at least in those numbers, without the lack of
Speaker 1: food or the rather the lack of access to food,
Speaker 1: because it's a complicated history, but food was still being
Speaker 1: produced and exported from Ireland during the famine. Anyway, another episode.
Speaker 1: That's another episode. Yeah, And as you heard in our
Speaker 1: first hand those who fled or were sent away by
Speaker 1: their landlords for North America, they often met a similar fate.
Speaker 1: I highly recommend reading more about this about gross eel
Speaker 1: Canada and the typhus epidemic that occurred there in eighteen
Speaker 1: forty seven there's also a great short story called ship
Speaker 1: Fever by Andrea Barrett in a book of short stories
Speaker 1: about science. It's like, I really enjoyed it. I read
Speaker 1: it a couple of years ago. And there's there's one
Speaker 1: like the Titular Story or whatever takes place on gross Isle,
Speaker 1: and it's so good, and we'll link to it on
Speaker 1: our website. Okay, But anyway, if you pick virtually any
Speaker 1: conflict or ecological disaster during the seventeen hundreds and eighteen hundred,
Speaker 1: you can be sure that Typhus was there. It was
Speaker 1: present during the American Civil War, although according to one
Speaker 1: paper I read, it wasn't as prevalent as you might expect.
Speaker 1: It was in Mexico associated with drought or crop failure,
Speaker 1: it was during the Thirty Years War. I mean, like
Speaker 1: you could list tons of different instances, and it's not
Speaker 1: difficult to see why Typhus flourished so well in war
Speaker 1: and in famine, and especially in northern climates or cooler seasons.
Speaker 1: Like let's say you're one of Napoleon's soldiers, or let's
Speaker 1: say you're an impoverished emmigrant fleeing the famine in Ireland.
Speaker 1: If the way you kill lice, Like you said, it's
Speaker 1: treatment alone is not enough. You have to kill the lice.
Speaker 1: And so if the way you kill lice is washing
Speaker 1: your clothes frequently, how do you do that when you're
Speaker 1: on a ship? You don't. How do you prevent yourself
Speaker 1: from becoming reinfested? You don't? I mean, do you are
Speaker 1: you even lucky enough to have one change of clothes?
Speaker 1: And if your soldier constantly on the move, and let's
Speaker 1: say you have a few changes of clothes, like, how
Speaker 1: are your clothes going to dry? Do you have soap
Speaker 1: or aren't they just going to freeze in the Russian
Speaker 1: winter and then never actually dry like.
Speaker 2: Well, and even just drying them alone, it isn't enough,
Speaker 2: like right, You have to wash them in hot enough water,
Speaker 2: or dry them in hot enough conditions, or leave them,
Speaker 2: like I said, completely unworn for at least five days,
Speaker 2: which that's it's impractical.
Speaker 1: Yeah, And and I think that that also kind of
Speaker 1: like is it serves as a good reminder of how
Speaker 1: ubiquitous body lice were. It was just normal to have
Speaker 1: body lice, right, And if you look at a disease
Speaker 1: like typhus, which has all but ceased to cause epidemics today,
Speaker 1: which Aaron, I know you'll talk more about the numbers,
Speaker 1: but I think it's easy to subconsciously think, well, you know,
Speaker 1: people just didn't know how it was transmitted. Gerom theory
Speaker 1: hadn't been developed yet. We have so much more knowledge
Speaker 1: and medical technology to prevent diseases like typhus today, so
Speaker 1: we'll never have to worry about it. And to a
Speaker 1: certain extent, that's true, right, Like knowing more about how
Speaker 1: it's transmitted certainly helps to prevent its spread, and being
Speaker 1: able to treat it or vaccinate against it has also
Speaker 1: helped to reduce the mortality associated with typhus. But how
Speaker 1: does that knowledge help, or that technology help, when you
Speaker 1: lack access to medical care or even the ability to
Speaker 1: regularly wash your clothes or have multiple changes of clothes.
Speaker 1: Typhus outbreaks, like many other infectious diseases, are not just
Speaker 1: a matter of bad luck or being in the wrong
Speaker 1: place at the wrong time, or not knowing how to
Speaker 1: protect yourself from the disease. They arise and spread in circumstances,
Speaker 1: often way beyond your control. And that's what I just
Speaker 1: kept getting from this reading about typhus, just this sense
Speaker 1: of total helplessness and horror. In these typhus outbreaks, the
Speaker 1: fever appears and there's simply nothing you can do but
Speaker 1: wait for it to get to you. Even if you
Speaker 1: know that it's an infectious disease and that it's transmitted
Speaker 1: by body lice, sometimes it's just that knowledge doesn't help you.
Speaker 1: So when did we learn those things? Well? In nineteen
Speaker 1: oh nine, Charles Nicole published his observation that the disease
Speaker 1: was transmitted through body lice, for which he was awarded
Speaker 1: the Nobel Prize in nineteen twenty eight. Although it wasn't
Speaker 1: until nineteen thirty eight I think that people realized it
Speaker 1: wasn't the bite of the laos, but rather the feces
Speaker 1: of the laos that transmits the pathogen and the causative
Speaker 1: agent of typhus. Rickettsie PRAWOZAKII was discovered really by several people,
Speaker 1: but it was named in nineteen sixteen by Enriq de Rochalima,
Speaker 1: a Brazilian doctor whose colleague Stanislas von Prowsek died of
Speaker 1: typhus while investigating it, just like Howard Ricketts, who also
Speaker 1: died of typhus. If you remember back to our Viking
Speaker 1: spotted fevers. Yeah, do you remember that? Yeah? And Ricketts
Speaker 1: died while investigating typhus in Mexico in nineteen ten, and
Speaker 1: so de Roshalima named the bacterium to honor these two
Speaker 1: researchers who lost their lives while studying the thing that
Speaker 1: killed them, which is sad.
Speaker 2: Yeah.
Speaker 1: And around the same time that De Roshalima named the bacterium,
Speaker 1: two researchers named Wheel and Felix developed the first zerological
Speaker 1: test for the disease, and more info seemed to be
Speaker 1: rolling in. Brill disease, as it was first known, had
Speaker 1: been described by Nathan Brill in the nineteen tens as
Speaker 1: he worked as a doctor treating Eastern European residents in
Speaker 1: New York's Lower East Side. It was a mild disease
Speaker 1: that he described, which is why he didn't consider it
Speaker 1: to be typhus initially, and it seemed especially prevalent among
Speaker 1: older people mourning the loss of a spouse, so he
Speaker 1: actually called it bereavement disease. Oh, fascinating, Yeah, which I
Speaker 1: can imagine that being a hugely stressful and traumatic experience.
Speaker 1: That way exactly what I was going to say, we activate, Yeah,
Speaker 1: but later it was shown by Hans Sincer to actually
Speaker 1: be this reactivated form, and so hence real Sincer fascinating.
Speaker 1: But again, even with all of this new knowledge being
Speaker 1: gained about the disease and the bacterium, it continued to
Speaker 1: cause devastating epidemics during World War One. In many countries
Speaker 1: in Eastern Europe, such as Poland, it turned endemic to
Speaker 1: epidemic among both civilians as well as soldiers. In Serbia
Speaker 1: in nineteen fourteen, after the Austrian invasion, Typhus broke out
Speaker 1: and caused a massive epidemic with an estimated five hundred
Speaker 1: thousand cases, of which one hundred and twenty thousand were fatal.
Speaker 1: Oh my goodness. During this epidemic, more than half of
Speaker 1: the physicians in Serbia died or were incapacitated by typhus
Speaker 1: whoa Overall during World War One, it was estimated to
Speaker 1: have infected between twenty and thirty million people. And once
Speaker 1: the war was over, it's not like Typhus just went away.
Speaker 1: Russia especially was in a great deal of turmoil and
Speaker 1: unrest with the Russian Revolution beginning in nineteen seventeen even
Speaker 1: before World War One ended, so there was like just
Speaker 1: chaos and yeah, and typhus took advantage of that. Between
Speaker 1: the years nineteen seventeen and nineteen twenty one, it's estimated
Speaker 1: that around twenty five million people in Russia became infected
Speaker 1: with typhus and two and a half to three million died.
Speaker 1: Like those numbers are they surprised me because it was
Speaker 1: just I didn't realize, Like I just didn't realize. And
Speaker 1: it was this huge epidemic in Russia, along with the
Speaker 1: enormous number of typhus infections during World War One, that
Speaker 1: inspired many people to start working on typhus vaccine, and
Speaker 1: several countries had entire research organizations devoted to this, which
Speaker 1: shows just how terrified of the disease that people were,
Speaker 1: and you know, rightly so. So. One of the most
Speaker 1: prominent of these typhus researchers in the years after World
Speaker 1: War One was a man named doctor Rudolph Weigel. Doctor
Speaker 1: Weigel was born in what is now the Czech Republic
Speaker 1: and lived most of his life in Levoff, which was
Speaker 1: then part of Poland now it's part of Ukraine. At
Speaker 1: his lab in Levoff, he made great strides with developing
Speaker 1: a vaccine for typhus that didn't entirely prevent the disease,
Speaker 1: but it did make it much less deadly if you
Speaker 1: contracted it. But he faced a problem that was common
Speaker 1: to anyone researching typhus or other ricketzial diseases. Rickettier were
Speaker 1: notoriously difficult to maintain in culture and lab settings, and
Speaker 1: it was also hard to get enough material to make
Speaker 1: the vaccine. Like the manufacturing side of it was hard.
Speaker 1: Mice in guinea pigs didn't really seem to become infected
Speaker 1: with rakeetsie prawozek yi, so they weren't a great solution. So,
Speaker 1: faced with this challenge, Wygel came up with another solution.
Speaker 1: Use the louse as the maintenance animal. Grind up infected
Speaker 1: lice and then inject that into the butts, like through
Speaker 1: the butts of uninfected lice to infect them to then
Speaker 1: you get more infected lice, you get to make more vaccine. Yeah, which,
Speaker 1: like that seemed to work actually through.
Speaker 2: The butts, Like that's so specific, I know.
Speaker 1: Well, it was something about like the kiteness or whatever,
Speaker 1: like the material was was like hard enough that you
Speaker 1: could like actually inject it in there without destroying this
Speaker 1: fragile little louse ye O, yeah, that makes sense. I
Speaker 1: believe it. That's pretty cool. Yeah, but how do you
Speaker 1: get enough lice to make enough vaccine?
Speaker 2: Well?
Speaker 1: Yeah, for that, you need a louse colony, and for
Speaker 1: that you hire louse feeders. No, yes, no, this was
Speaker 1: an actual job created by Weigel, and it's very cool.
Speaker 1: I'm going to get more into it now and later.
Speaker 1: But essentially, you strapped little boxes containing lice to your
Speaker 1: legs or arms and allow the lice inside those boxes
Speaker 1: to feed for a set amount of time okay, And
Speaker 1: if you happen to be one of those lucky louse feeders,
Speaker 1: you would be feeding up to thirty thousand lice at
Speaker 1: a time apparently, which would produce enough vaccine material for
Speaker 1: three hundred people in one week. Wow. Okay, that's pretty good.
Speaker 1: I feel like it's a pretty noble job. It was
Speaker 1: also decent paying, and I would say relatively safe, okay,
Speaker 1: because if you had never had typhus before, you were
Speaker 1: only allowed to feed the uninfected lice okay, And if
Speaker 1: you had had typhus then you could earn a bit
Speaker 1: more money by feeding the lice that were infected. But
Speaker 1: it did lead to some unfortunate side effects. Like blood
Speaker 1: loss and you know, allergic reactions on occasion. But still,
Speaker 1: by the nineteen thirties, Weigel's lab had become the world's
Speaker 1: typhus lab. People came from all over to study his
Speaker 1: louse colony and to learn how to make the Weigel vaccine. Basically,
Speaker 1: he would put as many as fifty lice into what
Speaker 1: was called the Weigel clamp, where their little life butts
Speaker 1: would were perfectly positioned for being injected with a slurry
Speaker 1: of their infected dead friends. Oh my gosh. And then
Speaker 1: those infected lice fed on more human blood, and then
Speaker 1: they were dissected. They're intestines removed and then homogenized, then centrifuged,
Speaker 1: then diluted with saline and phenol which would kill the bacteria,
Speaker 1: and then boom, there's your vaccine. Wow, it's basically just
Speaker 1: like you know, mushed up Laus intestines.
Speaker 2: Yeah, Laus intestines inactivated, Yeah, inactivated.
Speaker 1: As the the years went on, the need for Laus
Speaker 1: fears grew. As the need for the vaccine grew, especially
Speaker 1: as it became clear that war was on the horizon,
Speaker 1: and even before World War II began, Jewish academics in
Speaker 1: Poland faced many challenges, often being completely prohibited from working
Speaker 1: in academia. In nineteen thirty seven, for instance, a law
Speaker 1: was passed that Jewish people had to remain standing in
Speaker 1: university classes in Levolf, and Weigel, for his part, rejected
Speaker 1: these policies, for example by saying, well, I'm not going
Speaker 1: to sit down until they can sit down, which is
Speaker 1: something that many of his colleagues were either too afraid
Speaker 1: or too prejudice to do. But war was inevitable and
Speaker 1: German forces invaded Poland on September one, nineteen thirty nine,
Speaker 1: followed by Soviet troops, and Poland was partitioned between the two.
Speaker 1: During first the Soviet occupation and then the Nazi occupation
Speaker 1: of Levolf, Weigel was forced to keep working at his
Speaker 1: institute producing Typhus vaccine when so many other Polish intellectuals
Speaker 1: were being deported or imprisoned or just outright killed by
Speaker 1: both Soviet and Nazi troops. Why were Weigel and his
Speaker 1: labs still there, not just allowed to work, but like
Speaker 1: forced to work. Well, it's because Typhus was a terrifying threat,
Speaker 1: and so Weigel's work was viewed as invaluable and under
Speaker 1: German occupation, Weigel's institute grew rapidly, where it served as
Speaker 1: often the only means of survival from many Polish people
Speaker 1: who faced death, starvation, or deportation. Weigel went out of
Speaker 1: his way to hire hundreds of people as Laus feeders,
Speaker 1: often Polish intellectuals or Jewish people, people who were under
Speaker 1: incredible threat from Nazi occupation. And it's not certain exactly
Speaker 1: how many Polish people ended up working at the institute
Speaker 1: as Laus feeder, but it's been estimated between twelve hundred
Speaker 1: and three thousand, wow, which is a lot.
Speaker 2: Like, I also, I feel like this is one of
Speaker 2: those rare instances in this podcast where he's using humans
Speaker 2: in his research in a more ethical way.
Speaker 1: Yeah, no, I mean absolutely, like it's a job. Well,
Speaker 1: and I didn't include this, but like I also read
Speaker 1: that he was really hesitant or resistant to doing human
Speaker 1: trials of the vaccine. So like he had developed this
Speaker 1: vaccine in theory, but he was like, I don't want
Speaker 1: to test it on anyone. Yeah, it's dangerous to do,
Speaker 1: and so his research assistance like took it upon themselves.
Speaker 1: One guy injected his wife with a vaccine and then
Speaker 1: got an infected louse feed on her. I was like,
Speaker 1: excuse me, like that's that's a bit extreme. But but yeah,
Speaker 1: so other people did the you know, the I don't
Speaker 1: know if we can call them clinical trials, but yeah,
Speaker 1: he he did seem genuinely concerned. Yeah, and it is
Speaker 1: one of the rare instances. However, don't speak too soon,
Speaker 1: because there will be I've been waiting for it. Oh yeah, yeah,
Speaker 1: the other shoe will drop. Yeah. Yeah. So all of
Speaker 1: these people like this was their lifeline, right working as
Speaker 1: the louse feeders, and while feeding the lice, people often
Speaker 1: sat around and chatted, exchanging ideas about philosophy or mathematics
Speaker 1: or I read one description of a conversation about why
Speaker 1: salt is used to make ice cream, but it's also
Speaker 1: used to melt roads, like melt ice on roads, So
Speaker 1: how does that work? And there are some great pictures
Speaker 1: of the louse feeding and some of these common areas
Speaker 1: where people are just sitting around with louse cages on
Speaker 1: their bodies. I'll try to post those. But the conversation
Speaker 1: during the louse feeding it wasn't always about like, you know,
Speaker 1: philosophy or even trivial things. About half of the feeders
Speaker 1: were actively working in the resistance, and the louse feeding
Speaker 1: was a great cover right. It allowed them to get
Speaker 1: out of the house and also to have free time
Speaker 1: for underground activities. And the institute wasn't just a place
Speaker 1: for resistance talk but also resistance action. Workers would sabotage
Speaker 1: the Typhus vaccines intended for German soldiers, making them much
Speaker 1: less potent, while tens of thousands of full strength doses
Speaker 1: were smuggled out of the lab and into the Jewish ghettos,
Speaker 1: where licee infestation was incredibly high. Oh my goodness. Yeah,
Speaker 1: and just to illustrate again, because I think it's difficult
Speaker 1: to imagine how extreme infestation could be. So this is
Speaker 1: a quote from Henrik Spilman. I know that I mess
Speaker 1: up that pronunciation, and I'm sorry, describing lice in the
Speaker 1: Warsaw ghetto in his memory the pianist the lice quote
Speaker 1: crawled over the pavements, upstairways, and dropped from the ceilings
Speaker 1: of the public offices. Lys found their way into the
Speaker 1: folds of your newspaper, your small change. There were even
Speaker 1: lice on the crust of the bread you had just bought.
Speaker 1: And each of these verminous creatures could carry typhus. The
Speaker 1: black market vaccines from Weigel's lab did help save thousands
Speaker 1: of Jewish people from a death due to typhus, but
Speaker 1: few of these people survived the concentration camps that they
Speaker 1: were ultimately sent off to. So I don't think that
Speaker 1: I've adequately described yet just how terrified the Nazis were
Speaker 1: of typhus and how they used this fear as an
Speaker 1: excuse to enact horrific policies. Because Typhus wasn't seen as
Speaker 1: this universal threat from like oh this you know, bacteria
Speaker 1: or this louse, anyone could be impacted, it was of
Speaker 1: course blamed on Jewish people. Nazis used Typhus as part
Speaker 1: of the justification for the construction of Jewish ghettos, and
Speaker 1: public health orders for bathing and delousing often had this
Speaker 1: undertone of anti Semitism, like beards were ordered to be shaved,
Speaker 1: for instance, and just to note that there are no
Speaker 1: new evil ideas under the sun. This was not the
Speaker 1: first time that an ethnic group was blamed for the
Speaker 1: spread of typhus, and that Typhus was used as an
Speaker 1: excuse for genocide and murder. For instance, during World War One,
Speaker 1: there had been brutal medicalized torture carried out on prisoners
Speaker 1: of war or political prisoners, and also just like straight
Speaker 1: up genocide, like when nearly fifty thousand Armenian refugees were
Speaker 1: placed into concentration camps and most were murdered. With typhus
Speaker 1: often used as an excuse and upon entry into the
Speaker 1: Nazi concentration camps during World War II, people had to
Speaker 1: undergo disinfection and quarantine because the Nazi soldiers were incredibly
Speaker 1: scared of the disease spreading to them, hence the stripping
Speaker 1: and shaving and chemical baths. A single lause was sometimes
Speaker 1: used as an excuse to torture hundreds of people, but
Speaker 1: these quote sanitation efforts did next to nothing to stop
Speaker 1: the spread of the disease among those imprisoned in the
Speaker 1: concentration camps and prisoner of war camps. To illustrate, by
Speaker 1: November nineteen forty one, the German Army had captured one
Speaker 1: and a half million living Soviet prisoners of war and
Speaker 1: placed them in labor camps across Europe, where fifteen thousand
Speaker 1: died of typhus each day, yeah with additional deaths due
Speaker 1: to starvation and cold and likely other infectious diseases, and
Speaker 1: this massive increase in typhus prevalence put Germany in a
Speaker 1: typhus panic by nineteen forty two, and they looked beyond
Speaker 1: vaccines for help to prevent the spread. Zyklon B was
Speaker 1: developed as a disinfectant for lice as like a delousing agent,
Speaker 1: and it was found to be extremely successful in killing
Speaker 1: the lice, but it was also found to be extremely
Speaker 1: toxic to humans. Of course, this toxic side effect was
Speaker 1: included in the report of the chemical like for like,
Speaker 1: the final analysis of like this is you know where
Speaker 1: we stand in its development, and Heinrich Himmler happened to
Speaker 1: read this report and he was like, wait a second,
Speaker 1: I know where we can use this, and so it
Speaker 1: gave him the idea to use it in gas chambers
Speaker 1: in concentration camps. Like the fact that it was deadly
Speaker 1: to humans, and so zyklon b gas, which was originally
Speaker 1: developed as a delousing agent to prevent the spread of typhus,
Speaker 1: was used to mass murder millions of people at Auschwitz
Speaker 1: and at many other concentration camps. I know, I'm sorry,
Speaker 1: this is like a super difficult and sad and frustrating
Speaker 1: history to hear, but I think it's important to learn
Speaker 1: and remember.
Speaker 2: Yeah, you know, when you learn, or at least when
Speaker 2: I learned about the Holocaust, you hear about diseases in
Speaker 2: abstract like, yes, conditions were poor and infectious, disease was rampant,
Speaker 2: But to hear about it in more concrete terms, I
Speaker 2: think it's it's an important context.
Speaker 1: Yeah, exactly. Well put I struggled with like trying to
Speaker 1: articulate this in my notes, and I was just like,
Speaker 1: we need to learn about this, like and yeah, but
Speaker 1: there is so there's one more sad tidbit that I
Speaker 1: want to share because I think, again it's important to
Speaker 1: like learn this history. And then I'm going to talk
Speaker 1: about maybe not at uplifting, but an inspiring part of
Speaker 1: the story. Despite all of these, like I said, sanitation efforts,
Speaker 1: despite all of this fear surrounding the spread of typhus
Speaker 1: in concentration camps, the disease continued to spread there, like
Speaker 1: throughout the entire war. And I learned in researching this
Speaker 1: episode something I didn't know, which was that Anne Frank
Speaker 1: likely died in a typhus epidemic that killed seventeen thousand
Speaker 1: people at bergen Belsen in the last months of World
Speaker 1: War Two. I just I didn't you know, like you
Speaker 1: don't again, like you said, we learned about these diseases
Speaker 1: an abstract Oh, typhus killed this many people, and typhoid
Speaker 1: killed this many, and dysentery killed this many, but like
Speaker 1: it's yeah, yeah, placing it in the context. So there
Speaker 1: are no good estimates that I could find for the
Speaker 1: total number of people who died of typhus and concentration
Speaker 1: camps or prisoner of war camps during World War two,
Speaker 1: but I'm sure that it's a staggering number, all right.
Speaker 1: So now for a last, maybe slightly less depressing bit
Speaker 1: of World War II history. There was a Polish physician
Speaker 1: and biologist named Ludwig Fleck who worked alongside Weigel in
Speaker 1: his laboratory during the nineteen twenties, and like Weigel, he
Speaker 1: worked on typhus vaccines and typhus biology. But unlike Weigel,
Speaker 1: Fleck was Jewish and so was eventually excluded from academia entirely,
Speaker 1: just prohibited from working there, and so he started a
Speaker 1: private lab and he remained connected to the academic community
Speaker 1: as much as possible, and in many ways he was
Speaker 1: like way ahead of his time. Than his peers in
Speaker 1: terms of like the use of statistics in his research,
Speaker 1: and also in his philosophical approach to science. He was
Speaker 1: interested in the sociology of science, in the way that
Speaker 1: people thought about scientific questions, the philosophical matter of what
Speaker 1: is sickness and what is health like where does that line?
Speaker 1: And he felt very strongly that advancements in science and
Speaker 1: medicine were not made by one person, but by a
Speaker 1: community working together, a concept that would inspire Thomas Kuhn
Speaker 1: when writing his Structure of Scientific Revolutions a couple decades later.
Speaker 1: And Fleck was also concerned with the growing division between
Speaker 1: science and the humanities, and with the fact that as
Speaker 1: scientific knowledge grew, it became more inaccessible to non scientists.
Speaker 1: So I think we can really appreciate as a science podcast,
Speaker 1: we can really appreciate that last part in particular. But
Speaker 1: as a Jewish researcher in Nazi occupied Poland, he was
Speaker 1: not free to express any of these thoughts. Really, And
Speaker 1: this is a very condensed version of Fleck's story, And
Speaker 1: if you want to read more, I will recommend a
Speaker 1: book called Doctor Weigel's Fantastic Laboratory. But anyway, during the occupation.
Speaker 1: He was commandeered by SS doctors who first had him
Speaker 1: work at a Jewish hospital where he began working on
Speaker 1: a typhus vaccine to try to give to the Jewish
Speaker 1: patients that he treated, and to also smuggle it out
Speaker 1: to the ghettos as well. But unfortunately, the Nazis grew
Speaker 1: suspicious that he was trying to help people, and so
Speaker 1: they sent him and his family to first Auschwitz and
Speaker 1: then Buchenwald. Not as prisoners per se, I mean, although
Speaker 1: they were prisoners in everything but name right, like couldn't
Speaker 1: move freely or yeah, they always had the threat of
Speaker 1: death hanging over them. But he was sent there to
Speaker 1: conduct research on typhus, specifically vaccine. Horrifying medicalized torture plans
Speaker 1: were drawn up initially by the SS doctors in charge,
Speaker 1: of course, and there was medicalized torture carried out during
Speaker 1: World War Two, absolutely, but thankfully those specific plans were
Speaker 1: not something that Fleck had to carry out. Rather, he
Speaker 1: was tasked with making a vaccine for typhus to administer
Speaker 1: to Nazi soldiers, and he did, he was asked, But
Speaker 1: this vaccine was a vaccine in name only. It wasn't
Speaker 1: real It didn't do anything. Yeah, he and some of
Speaker 1: his colleagues who were in the know, were making a
Speaker 1: fake vaccine that was just absolutely nothing that they sent
Speaker 1: out to the German troops while at the same time
Speaker 1: making a real vaccine that they administered to the people
Speaker 1: who were imprisoned in the camps. Wow. And they kept
Speaker 1: up the charade when anyone suspected them of not sending
Speaker 1: a real vaccine, like people will come back and be like, hey,
Speaker 1: people are still getting sick. This vaccine isn't working. And
Speaker 1: so then they had like a little vial of real
Speaker 1: vaccine on the ready to be like, no, here it is,
Speaker 1: go ahead, test it, do what you want with it.
Speaker 1: And they they did this. So I just I love, like,
Speaker 1: I don't know, I really liked reading about that, that
Speaker 1: act of resistance. And they kept this up for like,
Speaker 1: you know, quite a bit of time. And the truth
Speaker 1: about this vaccine sabotage came out in the Nuremberg trials
Speaker 1: for the Nazi doctors, and when they learned about it,
Speaker 1: they were shocked and outraged. They were like, you haven't
Speaker 1: shown any humanity, How could you do that to us?
Speaker 1: And like literally when they said that people in the
Speaker 1: courtroom just laughed. They were like this, you haven't shown
Speaker 1: humanity because you gave fake, fake vaccine to people who
Speaker 1: were literally carrying out genocide. Okay, oh wow, Okay. So
Speaker 1: going back to I feel like what has become the theme
Speaker 1: of the history section. In World War Two? People knew
Speaker 1: what the causative agent of typhus was, they knew how
Speaker 1: it was transmitted, they could test for it, they could
Speaker 1: vaccinate against it. Even but yet it's still infected and
Speaker 1: killed an untold number of people, people from whom treatment
Speaker 1: or vaccines were withheld intentionally, people who were forced to
Speaker 1: live in conditions that were absolutely perfect for the spread
Speaker 1: of typhus. Outside of the concentration camps, typhus wasn't nearly
Speaker 1: as prevalent as it had been during the First World War.
Speaker 1: Most American troops, for example, were protected by the vaccine
Speaker 1: developed by Harold Cox at the Rocky Mountain Biological Labs
Speaker 1: in Hamilton, Montana, and shortly after the war, chloromphenacol and
Speaker 1: other antibiotics were found to be effective against typhus, which
Speaker 1: did help bring down like the mortality rate, but again,
Speaker 1: typhus lingers like it still lingers. It infected and killed
Speaker 1: many people in the gulag in the Soviet Union, for instance,
Speaker 1: And it often pops up when large groups of people
Speaker 1: are displaced due to conflict or ecological crisis. So I
Speaker 1: think I have three take home points from this, at
Speaker 1: least three. I mean, probably more that I'll realize, but whatever.
Speaker 1: Number one, Typhus is much more devastating and has had
Speaker 1: much more of an impact than I realized before doing
Speaker 1: this episode, like I wow. Yeah. And number two it
Speaker 1: just reinforces again the idea that medical technology and knowledge
Speaker 1: alone doesn't prevent disease. And three that Typhus may seem
Speaker 1: like a disease of the past, like a disease of
Speaker 1: just in the history books, but it's still here and
Speaker 1: it's unlikely to go away forever. It can and has
Speaker 1: popped up in these times of conflict, of food shortages
Speaker 1: or ecological disasters, and more of those are on the horizon. Yeah,
Speaker 1: and I don't really get the sense that we're prepared
Speaker 1: for that. So, Aaron, what's going on in the world
Speaker 1: of Typhus today? How is that segue? Oh gosh, Sharon.
Speaker 2: Let's say try and figure it out together.
Speaker 1: Okay. I like that I can do that.
Speaker 2: Right after this break. It turns out, Aaron, it is
Speaker 2: incredibly difficult to get solid numbers on epidemic typhus, like honestly,
Speaker 2: more so than I think any disease that we've covered
Speaker 2: so far. The World Health Organization doesn't even have a
Speaker 2: page or a fact sheet on typhus or any of
Speaker 2: the typhus fevers. I am shocked at how tough it was.
Speaker 2: I do not have for you global estimates.
Speaker 1: Period. That's period, okay, okay, Like I can't tell if
Speaker 1: that's reassuring or disturbing or both.
Speaker 2: Well, same time, I think it's both. So let's talk
Speaker 2: about the numbers I do have. So from nineteen eighty
Speaker 2: to nineteen ninety so in that ten year period, there
Speaker 2: were just over twenty thousand cases reported worldwide from at
Speaker 2: least one source that I found, So at least we
Speaker 2: have those numbers, right, But like you mentioned, this is
Speaker 2: a disease that tends to happen in clusters, in these
Speaker 2: outbreaks under certain circumstances. So in nineteen ninety seven, there
Speaker 2: was an outbreak, largely in Burundi that caused an estimated
Speaker 2: over one hundred thousand cases.
Speaker 1: It's wow, that's yeah. And incredible number.
Speaker 2: This is nineteen ninety seven, we have treatment, and yet
Speaker 2: the case fatality rate in that outbreak is estimated to
Speaker 2: be fifteen percent, which is DEBI stating.
Speaker 1: It just goes to show again it's like, what is
Speaker 1: what does that knowledge do right if you can't actually
Speaker 1: apply it exactly exactly.
Speaker 2: And to try and get more recent numbers, I found
Speaker 2: a bunch of papers looking at largely this group that
Speaker 2: I mentioned at the very top of the episode, these
Speaker 2: Typhus group ricketsioses. So there's a number of epidemiological studies
Speaker 2: or review papers that I found that were trying to
Speaker 2: get at the epidemiology of these Typhus group ricketsioses. So
Speaker 2: one of them was looking at these Typhus rickettsioses in
Speaker 2: China from twenty five to twenty seventeen, and that paper
Speaker 2: determined that there was a total of twenty nine thousand
Speaker 2: cases reported in that twelve year period. But it didn't
Speaker 2: distinguish between epidemic typhus and what they called endemic or
Speaker 2: this fleaborn or murine typhus. But it noted that based
Speaker 2: on the epidemiologic patterns, most of these cases fit the
Speaker 2: seasonal distribution and the kind of ecological distribution of endemic
Speaker 2: typhus not epidemic typhus. Okay, So that doesn't give us
Speaker 2: a lot of information about what we're focusing on for
Speaker 2: this episode, but suggests that the majority of typhus ricketsioses
Speaker 2: in China from twenty five to twenty seventeen was not
Speaker 2: epidemic typhus, so very low numbers, if any.
Speaker 1: Potentially. On the contrary, a similar.
Speaker 2: Data set in the US that was looking at data
Speaker 2: just from one healthcare like insurance group from two thousand
Speaker 2: and three to twenty sixteen identified just over seventeen hundred
Speaker 2: cases of typhus ricketsiosis. Again, this is just one healthcare
Speaker 2: group in the US, but around the same period of time,
Speaker 2: and in that case, over fifty percent of those were
Speaker 2: actually determined to be epidemic typhus and about forty percent
Speaker 2: were endemic or fleaborne typhus and the rest maybe some
Speaker 2: other ricketziosis. So that's quite different. Yeah. Another study that
Speaker 2: was looking at febrile illness in kids in Kenya, so
Speaker 2: this is just in children, and this is just sort
Speaker 2: of like a cohort study. This is from twenty eleven
Speaker 2: to twenty twelve, they found that one and a half
Speaker 2: percent of kids that came in with a fever tested
Speaker 2: positive for typhus group ricketsiosis. But again, this doesn't distinguish
Speaker 2: between epidemic and mirroring or endemic typhus.
Speaker 1: Huh.
Speaker 2: Yeah, And that paper also only had like three hundred
Speaker 2: and sixty kids, so it's low numbers to begin with.
Speaker 1: And the treatment for those two things is the same,
Speaker 1: right it is.
Speaker 2: Yeah, the treatment for all of this, all of the
Speaker 2: ricketsioses is the same as well as scrub typhus too,
Speaker 2: so that's at least convenient.
Speaker 1: That is quite convenient. Yeah.
Speaker 2: And another paper from the early two thousands that was
Speaker 2: looking at northern Africa. I was trying to get like
Speaker 2: global as global as I could.
Speaker 1: I didn't do a great job.
Speaker 2: But a paper that was looking in northern Africa found
Speaker 2: no cases of epidemic typhus, and all of the cases
Speaker 2: that they detected that reacted as positive for Ricketzia prawazekii
Speaker 2: turned out actually to be Rikkeetzia typhe. So it was
Speaker 2: all the endemic or mirroring typhus in that one study.
Speaker 1: So none of that.
Speaker 2: Gives us very much information to work with to try
Speaker 2: and understand anything close to like an annual number or
Speaker 2: or anything like that.
Speaker 1: Well, so, okay, people are clearly still infected or becoming
Speaker 1: infected occasionally. So is that evidence of brill sencer disease
Speaker 1: or is it just the fact that, like the conditions
Speaker 1: aren't often met or.
Speaker 2: Like it's so many good questions, Aaron. So in the US,
Speaker 2: most of the sporadic cases are associated with flying squirrels,
Speaker 2: so bizarre but true. In other places, it's very possible
Speaker 2: that it's maybe there's a case of burl zencer that
Speaker 2: then becomes a couple sporadic cases of you know, epidemic
Speaker 2: typhus actually transmitted by lice, but that because conditions aren't perfect,
Speaker 2: don't result.
Speaker 1: In a huge epidemic.
Speaker 2: But we just don't have the numbers to know, you know.
Speaker 2: And then it's also hard because in truth, our diagnostics
Speaker 2: are not great, and so really getting a handle on
Speaker 2: is it endemic typhus or is it epidemic typhus? You
Speaker 2: can look at the clinical picture like is it a
Speaker 2: less severe disease or is it more severe? But that's
Speaker 2: not perfect and a lot of times the tests that
Speaker 2: we have will cross react with a number of different ricketsiosis.
Speaker 2: So in a lot of parts of the world, we
Speaker 2: don't have great diagnostic We're not getting down to that
Speaker 2: nitty gritty.
Speaker 1: And if if the treatment for the two is the same, like,
Speaker 1: then does it does it matter? Does the dot? Yeah?
Speaker 1: I mean it does in like the epidemiological sense, but
Speaker 1: like for a doctor treating a patient, it doesn't doesn't.
Speaker 2: Well, it does though if there are lice, right, true,
Speaker 2: So let's talk about that for a second.
Speaker 1: Yeah, I was gonna say how many people have lice
Speaker 1: body lice, head lice.
Speaker 2: I don't have a number on how many people have it,
Speaker 2: but that would be a hard number to get.
Speaker 1: Be incredibly more difficult than type is.
Speaker 2: Yeah, but like you said, Aaron, lice are absolutely globally distributed.
Speaker 2: Body lice infestations occur worldwide, and predominantly they tend to
Speaker 2: affect areas or populations that don't have access to either
Speaker 2: change their clothes daily or to clean and dry their
Speaker 2: clothes in a way that actually kills lice that.
Speaker 1: Are living there.
Speaker 2: So very frequently outbreaks of lice infestation will follow large
Speaker 2: scale disasters like you talked about a lot in the
Speaker 2: history section, Aaron, Natural disasters war, political upheaval, refugee camps
Speaker 2: in urban settings. Body lice are also very prevalent among
Speaker 2: those experiencing homelessness, and I think I touched on this
Speaker 2: in our Bartnella episode, but in studies in the US
Speaker 2: and Europe, anywhere from five to thirty percent of unhoused
Speaker 2: people are found to be suffering from body lice. And
Speaker 2: what all of these situations have in common, of course,
Speaker 2: is things like crowding and poor sanitation, which lead to
Speaker 2: very efficient person to person transmission of body lice and
Speaker 2: persistence and transmission of these lice on clothing. So I
Speaker 2: think there's a lot of things that contribute to epidemic typhus,
Speaker 2: especially although I want to point out that scrub typhus.
Speaker 2: One paper that I read suggested that it's possibly the
Speaker 2: single most neglected disease, like oh, of all time, I mean, oh,
Speaker 2: very interesting.
Speaker 1: Well, and I definitely think we should do an episode
Speaker 1: on it at some point in the future, Like.
Speaker 2: It's very interesting. It's a very interesting one just in
Speaker 2: terms of how little people study it. But I think
Speaker 2: some of the big things that contribute to epidemic typhus
Speaker 2: being relatively understudied. Definitely, I would assume, though I don't
Speaker 2: have numbers on it, underfunded compared to a lot of
Speaker 2: other diseases today, despite it being such a massive problem historically,
Speaker 2: is because I think it's very easy to ignore the
Speaker 2: most vulnerable populations, who are the ones that are most
Speaker 2: likely to be affected by epidemic typhus in the case
Speaker 2: of an outbreak, right right, And it is in fact
Speaker 2: these most vulnerable populations forcibly displaced migrants, of which there
Speaker 2: are an increasing number year after year. And we talked
Speaker 2: in our dysentery episode about how many hundreds of millions
Speaker 2: of people live without access to sanitation and clean water facilities.
Speaker 2: If you don't have access to that, how are you
Speaker 2: going to keep lice off of your clothing?
Speaker 1: Right right?
Speaker 2: Yeah, And it's essentially inevitable at this point that, even
Speaker 2: barring any political instability or wars that may break out,
Speaker 2: climate change is going to result in increasing numbers of
Speaker 2: displaced people as the frequency and severity of natural disasters
Speaker 2: continues to increase. So, yes, yes, epidemic typhis might not
Speaker 2: be a problem right at this moment for much of
Speaker 2: the world.
Speaker 1: However, we cannot get comfortable, No, we really can't. We
Speaker 1: really truly can't. And I think we shouldn't be comfortable
Speaker 1: at this moment anyway, considering the fact that there are
Speaker 1: people who, if typhus were to break out, would be
Speaker 1: very susceptible, very vulnerable.
Speaker 2: Exactly because we know that things like malnutrition and all
Speaker 2: of these other things that go along with increasing your
Speaker 2: risk for severe disease or death, Like all of those
Speaker 2: things go hand in hand. It's really like tornadoes, perfect
Speaker 2: storm of the kinds of situations that lead to these
Speaker 2: epidemic typhus outbreaks.
Speaker 1: Yeah, I think that we often touch on the devastation
Speaker 1: that climate change could have, and it is like, in
Speaker 1: a more abstract sense, right every time that we talk
Speaker 1: about it, we're like, well, it's going to cause food
Speaker 1: and stability, it's going to cause a large movement of people,
Speaker 1: it's going to cause you know, et cetera, et cetera.
Speaker 1: But part of me wonders whether we're in this little
Speaker 1: in this nice little dip in the history of typhus
Speaker 1: right like right now, it declined rapidly and there's not
Speaker 1: really much going on, but it's really hard to see
Speaker 1: any way that it would stay at such little levels.
Speaker 2: I see the future Honestly, this season five opener is
Speaker 2: going to be akin to our season one opener where
Speaker 2: people listen to it several years later and are like, oh, how.
Speaker 1: Did you guys, how did you predict that?
Speaker 2: Which I mean, it's so interesting though, because it's one that,
Speaker 2: like I I never learned a lot about it in
Speaker 2: any of my epidemiology classes or in anything. You know,
Speaker 2: it's epidemic typhos, so it's you know, and I mean
Speaker 2: it is treatable, so there's that. But you know, are
Speaker 2: you going to be able to get not only antibiotic
Speaker 2: treatment but also like delousing treatment available to everyone in
Speaker 2: the midst of a disaster.
Speaker 1: No, you're not.
Speaker 2: It's not realistic.
Speaker 1: It's not realistic. Yeah, and I think it's interesting too,
Speaker 1: Like I read this somewhere and I think Aaron you
Speaker 1: and I were talking about this. But most typhus x
Speaker 1: berts around the world today have never seen an actual
Speaker 1: case of epidemic typhus.
Speaker 2: Right, yeah, like maybe you've seen endemic typis, maybe maybe
Speaker 2: scrub typhus, but.
Speaker 1: Yeah, yeah, not likely, Yeah, epidemic typhus. Yeah, this is
Speaker 1: a very big episode, which we always say.
Speaker 2: But hopefully we've helped someone make a case for funding.
Speaker 1: Yeah, I mean I think that's that's It's not the
Speaker 1: only answer, but I think it is a big answer
Speaker 1: to understanding not just basic research like where did Ricketzie
Speaker 1: PRAZAKII come from? Our body lies a headlines two different things,
Speaker 1: you know, that basic foundational knowledge, but also applied information
Speaker 1: and programs to help delaus and to help keep people
Speaker 1: from being you know, so susceptible to lovesborn diseases.
Speaker 2: Oh and because I don't think that this was made
Speaker 2: clear because you talked a lot about the various vaccines,
Speaker 2: oh right, that have existed in the past.
Speaker 1: No vaccine exists today. I was going to ask, but
Speaker 1: I kind of assumed. I feel like that's been the
Speaker 1: case for a few historic process Yeah.
Speaker 2: Yeah, And it's really because there have, like you said,
Speaker 2: been a lot of various different vaccines that have shown
Speaker 2: varying degrees of effectiveness, but none of them have been
Speaker 2: safe or effective enough to be licensed currently, And because
Speaker 2: of lack of funding and lack of a perceived market,
Speaker 2: there is no vaccine currently.
Speaker 1: Lack of a perceived market is.
Speaker 2: Yeah, well, on that note, yep.
Speaker 1: In typical TPWY fashion, we really started off with a
Speaker 1: depressing episode. But they they but it's important again, It's
Speaker 1: it's just.
Speaker 2: I think it's a really interesting one in so many
Speaker 2: different ways.
Speaker 1: It is so at least there is well, okay, on
Speaker 1: that note, shall we do sources?
Speaker 2: We should?
Speaker 1: Yeah, we shall Okay. I had a few books and
Speaker 1: a bunch of papers. The first book is The Fantastic
Speaker 1: Laboratory of Doctor Weigel by Arthur Allen, and that's all about, like,
Speaker 1: like I said, doctor Weigel and Doctor Fleck, and it's
Speaker 1: a really it's a really interesting read, very thorough look
Speaker 1: at a very small part of history, which is fascinating.
Speaker 1: And then also that collection of short stories called Ship
Speaker 1: Fever by Andrea Barrett, The Great Hunger Ireland eighteen forty
Speaker 1: five to eighteen forty nine by Cecil Woodham Smith and
Speaker 1: the first hand account came from the Ocean Plague by
Speaker 1: Robert White. And then of course I have to mention
Speaker 1: one of the most classic books in disease history or
Speaker 1: the history of disease, even though it kind of doesn't
Speaker 1: really it's not a great history of diseased book, but
Speaker 1: it's an interesting book anyway. It's called rats Lice in
Speaker 1: History by Hans Zencer and I have a ton of papers.
Speaker 1: I'm going to put them all on the website, so
Speaker 1: you know, please take your pick of them.
Speaker 2: Yeah, I also had a very large number of papers
Speaker 2: for this episode.
Speaker 1: I have a fair.
Speaker 2: Number on both scrub and mirring typhus. So if this
Speaker 2: episode left you hungering for more on those, there's a
Speaker 2: bunch of papers on both the biology and epidemiology of those.
Speaker 1: I think one of my favorite.
Speaker 2: Papers just on the general biology of typhus was just
Speaker 2: called Epidemic Typhus and that was published in the Lancet
Speaker 2: Infectious Diseases in two thousand and eight. But there were
Speaker 2: a whole bunch more, including all of the epidemiological studies
Speaker 2: that I mentioned at the end. So you can find
Speaker 2: all of our sources from this episode and every one
Speaker 2: of our eighty five other episodes on our website. This
Speaker 2: podcast will kill You dot com.
Speaker 1: Thank you to Bloodmobile for providing the music for this
Speaker 1: episode and all of our episodes.
Speaker 2: Thank you to the Exactly Right Network, of whom we're
Speaker 2: so proud to be a part. Have you listened to
Speaker 2: all of the other Exactly Right podcasts yet?
Speaker 1: You should? You should? And thank you to you listeners
Speaker 1: for tuning in to our season opener. We hope you
Speaker 1: liked it and it's gonna be a good season. I
Speaker 1: think it is, I know it is, I feel it is.
Speaker 2: And an extra thank you to our patrons.
Speaker 1: We love you so much, we truly truly do. Okay, Well,
Speaker 1: until next time, wash your hands, you filthy animals
Speaker 3: And o