CLASSICS IN SOCIAL MEDICINE Report on the Typhus Epidemic in Upper Silesia Rudolf Virchow (Archiv. für Patholog. Anatomie u. Physiologie u. für klin. Medicin, 1848, Vol. II, Nos. 1 and 2) CHAPTER 3. THE DISEASE showed excellent agreement in the different patients. Nevertheless, it is possible that, even A. SYMPTOMS so, my presentation of the facts might be The following communication relies to a incomplete in some points. This I fear mainly because my observations were made at a large extent on my own findings. These I relatively favorable season and because the obtained in part by observations made at the course of the disease might have been less military hospital in Sohrau, which is under the benign a little before or after. Correction of such direction of Dr. Sobeczko, a man as well versed points also must be left to other observers. as he is experienced, and in part by visits to In the normal course of the disease I believe patients in Rybnik, Sohrau, Pless, Ratibor, it convenient to discern four stages: a prodromal Loslau, Lonkau, Radlin, Geikowitz and Smollna. stage of early symptoms, one of peak The primary basis for this report, as well as for manifestation, one in which the disease abates, later control, was the information furnished by and lastly the stage of convalescence. the local physicians and by those foreign The symptoms, even the existence, of the physicians who had been residing in the area for first stage could only very rarely be recognized some time. Whenever my remarks are based among the rural population, as most of the solely on such information furnished, I shall members of that "class of society" pay too little expressly point it out. The great number of attention to slight symptoms to be able to give patients occurring in a relatively small area any information about them. A few, however, allowed me to form a general view of the stated definitely that they had felt unwell and different stages of the disease in a short time, so weak, had had pain in the joints, chills, that by combining the conditions observed in headaches, nausea, etc., before the disease had different individuals, a picture of the course of broken out. This prodromal stage was more the disease could soon be constructed. I have clearly apparent among foreigners, in particular later attempted to confirm the accuracy of this among the physicians who fell ill under endemic picture by sustained observation of individual influences. Dr. Beifel first felt so unwell on the cases at the military hospital. Results were 27th of February that he took the emetic he was further consolidated by the fact that the commonly prescribing at the beginning of the symptoms as well as the course of the disease disease; he then recovered to the extent that he resumed visiting his patients; on the 5th of Originally published in Archiv. für Patholog. Anatomie March, however, the disease reappeared so u. Physiologie u. für klin. Medicin, 1848. This English pronouncedly that he had to return to Breslau. translation is from Volume 1 of Virchow, Rudolf, Collected Essays in Public Health and Epidemiology, Prof. Kuh, whose definitely ascertained illness edited and with a foreword by L. J. Rather, published seems to date from the 19th of February, had in1985 by Watson Publishing International, Sagamore symptoms before that date which he himself had Beach, MA. Watson Publishing International retains considered to be due to catarrhal rheumatic sole copyright to this translation which it has kindly given us to reprint. All endnotes are from the original fever. In others, the symptoms between the translation inception of the disease and the appearance of Social Medicine (www.socialmedicine.info ) - 28 - Volume 1, No. 1, February 2006 clearcut manifestations were so indefinite that that information pointing to such later dates are all were deceived with regard to them. Prince doubtful. The majority of patients of all social Biron of Courland had a violent headache after a strata reckoned the start of their illness from the restless night on the 24th of February and felt so moment when it had reached so high a pitch that unwell that his personal physician, Dr. Altmann, they had to take to bed. From the cases urged him to return to Breslau. However, these mentioned it is plain that the disease might have symptoms receded, so that on the next day he already been present for at least 14 days, even continued to Pless. I there saw him on the 27th, though its manifestations were so mild and at a meeting of the local committee, most active vague that no physician was in a position to on behalf of the sick, showing the eagerness and assert its presence with certainty. circumspection which made his presence in the After the prodromal stage, the duration and districts so uncommonly beneficial. Later, at symptoms of which do not seem to be constant, dinner, he ate with a good appetite and has persisted for some time, there begins the conversed in a most lively fashion. The next second stage of the disease, which usually morning he returned to Breslau, where he busied reaches its peak very rapidly. In analogy to older himself in the interests of the Upper Silesians. authors it could be designated as the When I came to Breslau on the 9th of March, I inflammatory stage, because it presents a already found him on his sickbed, which a few number of symptoms of exaltation. However, days later was to become his deathbed. My the mainly depressive character of the affection, friend, Dr. von Frantzius, while returning from which will soon come to the fore, is also Vienna to Berlin, visited me in Pless and simultaneously apparent. The beginning of this accompanied me to Sohrau. There on the 5th of stage is frequently marked by the occurrence of March he complained for the first time of feeling chills and shivers, which the patients describe as indisposed. After a restless night he got up with similar to those of the ague, which they know so a headache and sore limbs; he had a slight fever well. Their duration is not constant; sometimes and a fit of shivering, with a dry, hot skin. these attacks lasted for 1-2 hours and were then Towards noon he had an exceedingly abundant followed by fever without sweating, or they outbreak of perspiration, which greatly relieved lasted for a short time only and were repeated him. During the following days he was quite after a few hours, or after a day or two. A few well; his appetite was even very good; he only patients mentioned only a slight feeling of felt somewhat tired; sometimes he complained chilliness lasting for a while; others denied any of slight pains in the limbs and he was rather feelings of chill whatsoever. quiet and listless. On the 10th, together with me, From then onward the rise of the skin he arrived in Berlin pursuing his business in a temperature was permanent. In general, the skin sober-minded way; he helped in building the was dry and the heat very soon became burning barricades on the 18th. The malady first struck (calor mordax), and that to a higher degree than with greater intensity on the evening of the 21st. I have ever seen in other diseases. When I It is easily understandable that such light placed my fingertips on the forearm of a patient and transient symptoms followed by almost for half a minute to count his pulse, a complete relief from all discomfort are not noted disagreeable prickling sensation sometimes by the great majority of patients and that there is persisted for as long as 10-15 minutes. It lasted a tendency to post-date the invasion of the longest in the lobes of my ears when I once disease to a much later time than the facts of the auscultated a patient by placing my bare ear case would warrant. I am drawing special against his back. Sometimes the skin was attention to this point in particular, as I shall covered with a slight sweat, which was not have to repeatedly come back to it so as to prove always sticky, but in that case the stinging Social Medicine (www.socialmedicine.info ) - 29 - Volume 1, No. 1, February 2006 sensation of the calor mordax became even belonged among the peculiarities of the disease. more repellent. Skin turgor was then always But it soon appeared that this pain occurred only increased, the face usually reddened, and the in the muscles, and that its apparently greater eyes somewhat injected and shining. intensity in the places mentioned only stemmed The intensity of the fever, inasmuch as it from their being more thoroughly examined. was directly apparent from the circulatory Enlargement of the spleen, sometimes very system, differed according to the nutritional extensive, was frequently diagnosed by condition of the individual. In strong and well- palpitation and percussion; however, all these fed people the fever exhibited a somewhat patients had previously suffered from malaria, inflammatory character during the first days. which they had treated themselves. In those who The contractions of the heart were frequent and had remained free from intermittent fever, there energetic; counts of 96, 100, 104 and more was no tumor of the spleen. rather large and full beats were soon reached; A moderate bronchial catarrh with a the tension of the arterial walls, however, was frequent urge to cough was almost universal rarely strong enough to offer a noticeable during this period; the cough was tormenting, resistance to the pressure of the fingers.