History, Rats, Fleas, and Opossums: The Ascendency of Flea-Borne Typhus in the United States, 1910-1944

Abstract

Flea-borne typhus, due to Rickettsia typhi and Rickettsia felis, is an infection causing fever, headache, rash, hepatitis, thrombocytopenia, and diverse organ manifestations. Although most cases are self-limited, 26%-28% have complications and up to one-third require intensive care. Flea-borne typhus was recognized as an illness similar to epidemic typhus, but having a milder course, in the Southeastern United States and TX from 1913 into the 1920s. Kenneth Maxcy of the US Public Health Service (USPHS) first described the illness in detail and proposed a rodent reservoir and an arthropod vector. Other investigators of the USPHS (Eugene Dyer, Adolph Rumreich, Lucius Badger, Elmer Ceder, William Workman, and George Brigham) determined that the brown and black rats were reservoirs and various species of fleas, especially the Oriental rat flea, were the vectors. The disease was recognized as a health concern in the Southern United States in the 1920s and an increasing number of cases were observed in the 1930s and 1940s, with about 42,000 cases reported between 1931-1946. Attempts to control the disease in the 1930s by fumigation and rat proofing and extermination were unsuccessful. The dramatic increase in the number of cases from 1930 through 1944 was due to: the diversification of Southern agriculture away from cotton; the displacement of the smaller black rat by the larger brown rat in many areas; poor housing conditions during the Great Depression and World War II; and shortages of effective rodenticides and insecticides during World War II.

Keywords: Rickettsa typhi; Rickettsia felis; fleas; insecticide; murine typhus; rats; rodenticide.

Figure 1

The Pioneers. (Left) James E. Paullin. Paullin described the first cases of flea-borne typhus (FBT) in 1913 while at Grady Hospital in Atlanta, GA. Paullin later served as physician to President Franklin Roosevelt [82]. (Right) Kenneth F. Maxcy of the US Public Health Service. Maxcy was among the first to propose a rodent reservoir for FBT and published the first comprehensive clinical description of “endemic typhus”. In 1952 Maxcy was awarded the Sedgwick Memorial Medal for Distinguished Service in Public Health, the most prestigious award of the American Public Health Association [83].

Figure 2

Typhus triumvirate of the United States Public Health Service: (left) Eugene Rollo Dyer; (center) Adolph Rumreich; (right) Lucius Badger. Along with William Workman and Elmer Ceder, these men determined that FBT has a domestic rodent reservoir and is transmitted by the flea feces and discovered the vector potential of the Oriental rat flea. In 1931, the team also differentiated FBT from Rocky Mountain spotted fever (RMSF). For his work on typhus, Dyer was awarded the Sedgwick Memorial Medal for Distinguished Service in Public Health in 1950 [83].

Figure 3

Typhus troika working at the American Hospital in Mexico City: (left) Hermann Mooser; (center) Maximiliano Ruiz Casteñada; (right) Hans Zinsser. They also determined that rats harbor the FBT rickettsiae [107].

Figure 4

The rat ridders. (upper) Texas rat killing squad, 1930s, proudly displaying their quarry [136]. (lower) Men holding traps and dead rats in Geneva County, Alabama as part of a rat eradication project of the Civil Works Administration, 22 February 1934.

Figure 5

Works Progress Administration workers preparing rodenticide torpedoes (typically a mixture of red squill with either meat, fish, or grain, wrapped in paper), New Orleans, 1936.

Figure 6

Works Progress Administration workers nailing rats to shingles for inspection, New Orleans, 1936.

Figure 7

Works Progress Administration technician removing fleas from rat for quantification and identification, New Orleans, 1936.

Figure 8

(upper) Entrance portals for rats blocked by vent stoppage: metal flashing around edge of a wooden door, screening for a window, and a perforated metal grate [156]. (lower) Men involved in vent stoppage against rats in San Antonio, TX, likely late 1930s/early 1940s.

Figure 9

Don’t feed rats. Combat the rat. This US Public Health Service poster from 1944 encourages the proper disposal of food waste.

Figure 10

Truck for rat proofing, promoting the use of rat poison torpedoes. Charleston, SC, 1939.

Figure 11

Men pumping calcium cyanide powder (Cyanogas^TM) into rat burrows at a city dump. This compound reacts with moisture and releases hydrogen cyanide gas [156].

Figure 12

Flea-borne typhus fever cases in the United States, 1920–1987 [1].