American Journal of Epidemiology Vol. 85, No. 3: 333-355
Copyright © 1967 by The Johns Hopkins University School of Hygiene and Public Health
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AN EPIDEMIOLOGICAL STUDY OF ENDEMIC TYPHUS (BRILL'S DISEASE) IN THE SOUTHEASTERN UNITED STATES WITH SPECIAL REFERENCE TO ITS MODE OF TRANSMISSION
U.S.P.H.S.
Readers of The American Journal of Hygiene will recall the dedication of Volume 60 in 1954 to Dr. Kenneth F. Maxcy, who had just retired as Professor of Epidemiology at the Johns Hopkins School of Hygiene and Public Health and who had for a number of years served as chairman of the Editorial Board.
Dr. Maxcy's death occurred on December 12, 1966. The present editorial board decided that, as a further tribute to him, it would reprint one of his early papers, originally published in Public Health Reports, Volume 41, No. 52, pp 2967–2995, December 21, 1926. We are grateful to the editors of Public Health Reports for permission to do this.
The paper selected is one from early in Dr. Maxcy's career when he was with the United States Public Health Service. For several years he carried on clinical and epidemiologic studies of a typhus-like disease which occured sporadically in the southeastern United States. While some of his supervisors in the Service were of the opinion that it must be classical louse-borne typhus, he came to a different conclusion as set forth in a series of papers, of which this one presents the epidemiologic features of the disease and the inferences which he drew from those features. These inferences were shown to be correct by laboratory studies subsequently done by Dyer, Rumreich and Badger and others. The paper represents a demonstration of the power of the epidemiologic method, properly employed, in elucidating the mode of transmission of a disease.
Some epidemiologists who have made contributions on the transmission of infectious disease, before the bacteriological era, have received little recognition even after their findings had been confirmed in the laboratory. This was true, for example of John Snow, whose field studies demonstrating the transmission of cholera by water antedated the discovery of the vibrio by 30 years and the first bacteriologically confirmed water-borne outbreak by 40 years; his work received relatively little attention or credence until publicized by Sedgewick, Rosenau and Frost in this country during the present century. It is gratifying to be able to record that Dr. Maxcy, on the other hand, received full credit for his work on typhus from the outset.
The italicized statements in the report were in italics in the original paper as published. Two tables (3 and 4, on pages 2991–2993 of original article), consisting of lists of patients in Montgomery and Savannah, have been omitted in the present reprinting in order to save space. The implied identification of the disease which Dr. Maxcy studied with Brill's disease is, of course, incorrect: Subsequent studies by Zinsser have shown that Brill's disease is a recrudescence of classical Old-World typhus fever; clinically and in respect to the absence of lice, however, it could not be distinguished from endemic typhus fever.
In addition to the principal purpose of honoring Dr. Maxcy, we believe that making this paper more readily available to contemporary readers will serve a useful purpose for students of epidemiology.