La batalla decisiva contra la fiebre tifoidea en Santiago de Chile en el siglo XX / The decisive battle against typhoid fever in Santiago de Chile in the twentieth century

Hasta 1983, cuando alcanzaba la increíble tasa de 118 casos por 100.000 habitantes, la fiebre tifoidea era la peor amenaza infecciosa en Santiago, Chile, ciudad que figuraba junto a Ciudad de México, El Cairo y Bombay, como una de las con mayor endemia en el mundo. El Ministerio de Salud respondió formando el Comité de Tifoidea de Chile, con participación de expertos nacionales y del grupo de Myron Levine, de la Universidad de Maryland, que llevó a cabo ingeniosas investigaciones, culpando al río Mapocho, cuyas aguas contaminadas con Salmonella typhi regaban los predios agrícolas vecinos, conformando así un ciclo largo de infección. Las vacunas antitíficas ensayadas (oral Ty21a atenuada y polisacárido capsular Vi inyectable) no mostraron eficacia, los portadores crónicos no se trataron, pero una campaña sanitaria a través de la televisión contribuyó decisivamente a mejorar los hábitos higiénicos de la población, fortalecida por el pánico que causó la llegada del cólera en 1991, y la fiebre tifoidea prácticamente desapareció del escenario.

Until 1983, when reached the incredible frequency of 118 cases for 100.000 habitants, typhoid fever was the worst infectious threat in Santiago, Chile, city that appeared next to Mexico City, Cairo and Bombay, as one of the most endemic in the world. The Ministry of Health responded with the creation of The Chilean Typhoid Committee, with the participation of national experts and Myron Levine's group, which carried out ingenious investigations blaming the Mapocho River, whose waters contaminated with Salmonella typhi irrigated the neighboring farms, thus conforming a long cycle of infection. Typhoid vaccines tested (strain Ty 21a oral and Vi capsular polysaccharide) did not show efficacy, chronic carriers were not treated, but a health campaign on television made a decisive contribution to improving hygiene habits of the population, strengthened by the panic caused by the arrival of cholera in 1991, and typhoid fever practically disappeared from the stage.

[Thomas Mann and infectious diseases in the first half of the 20th century. Part I: Typhoid fever, meningitis and syphilis]. / Thomas Mann y las enfermedades infecciosas en la primera mitad del siglo XX. Parte I: Fiebre tifoidea, meningitis y sífilis.

Surely, Thomas Mann is today a forgotten writer, with only a little and precious group of readers between our young colleagues. However, perhaps could be useful for the others some knowledge about his vision of the infectious diseases in the first half of the twentieth century, when he wrote the novels here reviewed. Typhoid fever, meningitis, tuberculosis, syphilis and cholera are present in Mann's thematic from Buddenbrooks till Doktor Faustus, always with a personal focus, more on spirit -the will to live - rather than on flesh and bones… or bacteria. One of his later and minor works let us throw an ironical glance over transplant, no so named, indeed, by Mann, who speaks of "exchange". In this first part we present typhoid fever, meningitis and syphilis.

Algunas notas sobre el desarrollo histórico de la fiebre tifoidea en Chile / Some information regarding the historical development of typhoid fever in Chile

Resumen En el desarrollo histórico de la fiebre tifoidea en Chile, destaca su confusión con otras patologías infecciosas, especialmente con el tifus exantemático, problema que se resolvió mayormente con ocasión de la epidemia de 1918 de dicha enfermedad. Además se resalta la importancia del tratamiento con cloranfenicol, que significó una mejoría extraordinaria de las fiebres tifo-paratíficas, además de las acciones de salud pública y educación sanitaria, que permitieron prácticamente terminar con dichas patologías infecciosas en el país.

During the historical development of typhoid fever in Chile, its confusion with other infectious diseases is particularly noteworthy, especially with murine typhus, a problem that was mainly resolved during the 1918 epidemic. The importance of chloramphenicol treatment is also highlighted, which meant an enormous improvement in typhoid/paratyphoid fevers, in combination with public health and health education actions that allowed to almost eliminate these infectious diseases in our country.

[Some information regarding the historical development of typhoid fever in Chile]. / Algunas notas sobre el desarrollo histórico de la fiebre tifoidea en Chile.

During the historical development of typhoid fever in Chile, its confusion with other infectious diseases is particularly noteworthy, especially with murine typhus, a problem that was mainly resolved during the 1918 epidemic. The importance of chloramphenicol treatment is also highlighted, which meant an enormous improvement in typhoid/paratyphoid fevers, in combination with public health and health education actions that allowed to almost eliminate these infectious diseases in our country.

Debating Diseases in Nineteenth-Century Colombia: Causes, Interests, and the Pasteurian Therapeutics.

This article explores the medical conceptualization of the causes of diseases in nineteenth-century Colombia. It traces the history of some of the pathologies that were of major concern among nineteenth-century doctors: periodic fevers (yellow fever and malaria), continuous fevers (typhoid fever), and leprosy (Greek elephantiasis). By comparing the transforming conceptualizations of these diseases, this article shows that their changing pattern, the idea of climatic determinism of diseases (neo-Hippocratism and medical geography), the weak standing of the medical community in Colombian society, as well as Pasteurian germ practices were all crucial in the uneven and varied reshaping of their understanding.

Typhoid Fever in nineteenth-century Colombia: between medical geography and bacteriology.

This paper analyses how the Colombian medical elites made sense of typhoid fever before and during the inception of bacteriological ideas and practices in the second half of the nineteenth century. Assuming that the identity of typhoid fever has to be understood within the broader concerns of the medical community in question, I show how doctors first identified Bogotá's epidemics as typhoid fever during the 1850s, and how they also attached specificity to the fever amongst other continuous fevers, such as its European and North American counterparts. I also found that, in contrast with the discussions amongst their colleagues from other countries, debates about typhoid fever in 1860-70 among doctors in Colombia were framed within the medico-geographical scheme and strongly shaped by the fear of typhoid fever appearing alongside 'paludic' fevers in the highlands. By arguing in medico-geographical and clinical terms that typhoid fever had specificity in Colombia, and by denying the medico-geographical law of antagonism between typhoid and paludic fevers proposed by the Frenchman Charles Boudin, Colombian doctors managed to question European knowledge and claimed that typhoid fever had distinct features in Colombia. The focus on paludic and typhoid fevers in the highlands might explain why the bacteriological aetiology of typhoid fever was ignored and even contested during the 1880s. Anti-Pasteurian arguments were raised against its germ identity and some physicians even supported the idea of spontaneous origin of the disease. By the 1890s, Pasteurian knowledge had come to shape clinical and hygienic practices.

Recuerdo histórico y comentario sobre "la epidemia tifoidea de la Isla de Huar. Provincia de Llanquihue / Historic memory and commentary about

Se recuerda y comenta la publicación en el primer número de Revista Médica de Chile (1872-73) del doctor Carlos Martin, de una epidemia ocurrida en la isla de Huar en el seno de Reloncavi (Xª Región de Los Lagos, Chile), descrita como "epidemia tifoidea" y se expone la fisonomía clínica deduciendo la posibilidad de dos tipos de patologías: infecciones respiratorias agudas y fiebre tifoidea.(AU)

Recuerdo histórico y comentario sobre "la epidemia tifoidea de la isla de Huar: Provincia de Llanquihue" / Historic memory and commentary about "typhoid fever epidemic at Huar Island": Llanquihue province

An article by Dr. Carlos Martin in the first published number of the Revista Médica de Chile (1872-73) journal is remembered and commented. It describes an outbreak in Huar Island in Seno de Reloncavi, an estuary located in the Los Lagos Region in Chile, named "typhoid epidemic". The clinical characteristics are presented and two types of diseases are deducted: acute respiratory infections and typhoid fever.

Se recuerda y comenta la publicación en el primer número de Revista Médica de Chile (1872-73) del doctor Carlos Martin, de una epidemia ocurrida en la isla de Huar en el seno de Reloncavi (Xª Región de Los Lagos, Chile), descrita como "epidemia tifoidea" y se expone la fisonomía clínica deduciendo la posibilidad de dos tipos de patologías: infecciones respiratorias agudas y fiebre tifoidea.

[Historic memory and commentary about "typhoid fever epidemic at Huar Island": Llanquihue province]. / Recuerdo histórico y comentario sobre "la epidemia tifoidea de la isla de Huar: Provincia de Llanquihue"

An article by Dr. Carlos Martin in the first published number of the Revista Médica de Chile (1872-73) journal is remembered and commented. It describes an outbreak in Huar Island in Seno de Reloncavi, an estuary located in the Los Lagos Region in Chile, named "typhoid epidemic". The clinical characteristics are presented and two types of diseases are deducted: acute respiratory infections and typhoid fever.

Fiebre tifoidea: Emergencia, cúspide y declinación de una enfermedad infecciosa en Chile / Typhoid fever: rise, peak and fall of an infectious disease in Chile

En este artículo se presenta la historia de la fiebre tifoidea (FT) en Chile desde su reconocimiento como entidad nosológica hasta su situación actual. De la historia destaca la confusión que hubo en Chile durante muchos años entre esta enfermedad y el tifus exantemático a pesar de que la fiebre tifoidea ya había sido individualizada y caracterizada en la primera mitad del siglo XIX en Europa. Esto se podría explicar porque tenían ciertas manifestaciones clínicas similares (fiebre alta y delirio) y por ocurrir en condiciones de déficit ambiental. Esta confusión se soluciona recién en 1918 en relación con la gran epidemia de tifus exantemático que permite a los clínicos identificarlo con toda claridad. Una vez distinguida la FT fue posible describir su comportamiento, caracterizado por un alto nivel de endemia, de preferencia en zonas urbanas con alzas estivales y ciclos epidémicos. De la historia contemporánea de la FT resalta la Gran Epidemia de 1976-1985, asociada al brusco deterioro socioeconómico y ambiental, y la igualmente abrupta caída de la enfermedad en 1992, reducción que persiste hasta nuestros días. Este último fenómeno, fue el resultado del carácter cuasi-experimental de las intervenciones de salud pública y educación sanitaria realizadas en 1992 para evitar la epidemia de cólera que estaba extendiéndose en el Perú. Concluimos que, si bien la hipótesis de la contaminación ambiental como el factor clave en la persistencia de la FT estuvo presente desde el reconocimiento de la enfermedad en 1894, sólo se abordó de manera eficaz y tal vez definitiva casi 100 años más tarde

This article presents the history of typhoid fever in Chile since its definition as a clinical entity until our days. From this history is evident the long lasting confusion with typhus (rickettsial spotted fever) in Chile although the identity and characteristics of typhoid fever had been established in the first half of nineteenth century in Europe. This confusion could be explained because some clinical features are similar in both diseases (high fever and delirium) and because of its ocurrence in poor hygienic conditions. This misconception was resolved only during 1918 on occasion of a major typhus outbreak that allowed physicians to clearly diagnose this rickettsial disease. Once typhoid fever was recognized it was possible to describe its epidemiological pattern with high endemic incidence mainly in urban districts, with summer increases and epidemic cycles. In the contemporary history of typhoid fever it is remarkable a huge outbreak during 1976-1985, associated to abrupt socioeconomical and environment crisis, as well as an abrupt diminution of the disease in 1992, with a marked reduction that persists until now. This last phenomenon was the consequence of a cuasi-experimental public health intervention and sanitary education conducted in 1992 to avoid the cholera epidemic that was spreading in Perú, a neighboring country. We conclude that, although the hypothesis of environment contamination as the cornerstone in typhoid persistence was present since the recognition of the disease in 1894, it was faced efficiently only and perhaps in a definitely manner only almost 100 years later

[Typhoid fever: rise, peak and fall of an infectious disease in Chile]. / Fiebre tifoidea: Emergencia, cúspide y declinación de una enfermedad infecciosa en Chile.

This article presents the history of typhoid fever in Chile since its definition as a clinical entity until our days. From this history is evident the long lasting confusion with typhus (rickettsial spotted fever) in Chile although the identity and characteristics of typhoid fever had been established in the first half of nineteenth century in Europe. This confusion could be explained because some clinical features are similar in both diseases (high fever and delirium) and because of its occurrence in poor hygienic conditions. This misconception was resolved only during 1918 on occasion of a major typhus outbreak that allowed physicians to clearly diagnose this rickettsial disease. Once typhoid fever was recognized it was possible to describe its epidemiological pattern with high endemic incidence mainly in urban districts, with summer increases and epidemic cycles. In the contemporary history of typhoid fever it is remarkable a huge outbreak during 1976-1985, associated to abrupt socioeconomical and environment crisis, as well as an abrupt diminution of the disease in 1992, with a marked reduction that persists until now. This last phenomenon was the consequence of a quasi-experimental public health intervention and sanitary education conducted in 1992 to avoid the cholera epidemic that was spreading in Perú, a neighboring country. We conclude that, although the hypothesis of environment contamination as the cornerstone in typhoid persistence was present since the recognition of the disease in 1894, it was faced efficiently only and perhaps in a definitely manner only almost 100 years later.

As febres paulistas na Sociedade de Medicina e Cirurgia de Säo Paulo: uma controvérsia entre porta-vozes de diferentes saberes / Febres paulistas and the Säo Paulo Society of Medicine and Surgery: a controversy among spokespeople from different arenas of knowledge

Trata dos debates científicos travados em torno de uma doença classificada pelos médicos da cidade de Säo Paulo, no fim do século XIX, como febres paulistas. Elaborou-se uma pequena revisäo acerca do papel das febres na nosologia brasileira do período e apresentam-se as idéias entäo em voga para explicar as febres paulistas, a malária e a febre tifóide, centrando o foco sobre as transformaçöes no campo médico que fizeram com que essas febres deixassem de ser identificadas como formas de malária e passassem a ser classificadas como casos de febre tifóide. (AU)

Tifo e gripe espanhola mensageiros da morte: Curitiba - 1917-1918 / Typhoid fever and influenza - messengers of death

Analisa as ocorrências em torno do Tifo e da Gripe Espanhola, tomando Curitiba como espaço e os anos 1917 (Tifo) e 1918 (gripe Espanhola) como cronologia. Procura reconstruir a partir da capital do Paraná, a açäo, as suas relaçöes, as profilaxias, a higiene sanitária, o saneamento básico e o controle das doenças a partir das políticas públicas.(AU)