Encoding: 154 TEXT
X-Mailer: Microsoft Mail V3.0
Newsgroups: soc.roots
Date:         Wed, 27 Jan 1993 13:07:00 EST
Reply-To:     SLR2@CCDDCD1.EM.CDC.GOV
From:         SLR2@CCDDCD1.EM.CDC.GOV
Subject:      Re: Pest house & Typhus
Comments: To: ROOTS-L@VM1.NoDak.EDU

>>>  The doctor said I had 'Typhus' which I now understand to be typhoid
>>>  fever.

>>>  While all this stuff sounds a bit melodramatic, even to me, what my mom
>>>  said happened was that the doctor, a Russian soldier, gave me a direct
>>>  blood transfusion from himself and saved my life. I've no idea why the
>>>  blood transfusion, maybe some nourishment and other care really did the
>>>  job.

>>>  Thanks Susan. More material for my story. But why the blood transfusion?

>>>  Fred
>>>  --
>> W. Fred Rump    office:    fred@COMPU.COM     "A man's library is a sort of
>>>  26 Warren St.   home: fr@icdi10.compu.com       harem" - Emerson (1860)
>>>  Beverly, NJ. 08010
>>>  609-386-6846    bang:uunet!cdin-1!icdi10!fr


I suspect there is some confusion in the Dx (diagnosis) typhus or typhoid,
though the Russian medical establishment is known do things that Western
medicine considers or perceives to be unorthodox.  It is likely you were
malnourished and anemic, given your personal account of the immediate
post-WWII conditions in Berlin.  A blood transfusion might have some
transient benefit in ameliorating that situation in your body.  The doctor
may have also been attempting to confer immunity to you by transfusing blood
from himself (assuming he had just recovered from the infectious disease you
had) into to you while you were suffering from the presumed same illness.
This is called a reciprocal transfusion, because simultaneously the doctor
should have been transfusing an equal amount of your blood (the sick person)
back into himself.  The doctor may not have had any antibiotics available to
give to you that would be effective in treating typhoid fever.  That's a
possible explanation for why he gave you a direct blood transfusion.

Apparently, your blood and the doctor's was antigenically similar (ie:  your
body did not adversely react to his blood type.  Thus your and his blood
types were compatible.)  I don't know if the doctor tested your and his
blood groups before transfusing you with his blood.  There would have been a
risk of a transfusion reaction.  A transfusion reaction is a cytotoxic (cell
killing) reaction that accompanies or follows administration of blood or
blood components.  Its severity varies from mild (fever or chills) to severe
(acute renal failure or complete vascular collapse and death) with the amount
of blood transfused, the type of reaction in the patient, and the patient's
general health.  Your general health at the time was poor.  Most severe
transfusion reactions occur with whole blood.  The use of blood components
radically decreases the possibility of a reaction.  Transfusion reactions can
be hemolytic, caused by administration of mismatched blood (ABO group, Rh
incompatibility), or nonhemolytic, caused by patient sensitivity to infused
components.

To prevent transfusion reactions, before giving a blood transfusion, a
doctor or nurse must be certain of the hospital policy about giving blood,
then, MAKE SURE THAT THEY HAVE THE RIGHT PATIENT AND THE RIGHT BLOOD FOR THAT
PATIENT!  Sorry I don't mean to yell, it's just that is soooooo critical.

It sounds as if you had protein-calorie malnutrition (PCM), which is one of
the most prevalent and serious depletion nutritional disorders.  PCM occurs
as marasmus (protein-calorie deficiency), characterized by growth failure and
wasting, and as kwashiorkor (protein deficiency), characterized by tissue
edema (swelling due to fluid accumulation) and damage.  Both forms of PCM
vary from mild to severe, and may be fatal depending on accompanying stress
(particularly systemic infections, severe burns and injuries, and cancer) and
duration of deprivation.  PCM increases risk of death from pneumonia, chicken
pox, or measles.  Chronic kwashiorkor typically occurs in children after age
1, after a child is weaned from breast milk to a protein-deficient diet of
starchy gruels or sugar water. Kwashiorkor can develop at any time during the
formative years.  Chronic Kwashiorkor allows the patient to grow in height,
but adipose (fat) tissue diminishes as fat is metabolized to meet energy
demands.  Edema often masks severe muscle wasting (that's why starving
children often have swollen bellies - they also usually have a gut full of
intestinal parasites, such as worms); dry, peeling skin and hepatomegaly
(liver enlargement) are common.  To help eradicate PCM in developing
countries today, prolonged breast feeding is encouraged, mothers are educated
about the nutritional needs of children, and supplementary foods are
provided, as needed.  In addition, prolonged breast feeding prevents
consumption of contaminated water used in reconstituting baby formula.  The
pathogens in contaminated water can cause a whole host of fatal illnesses in
an infant and toddler, or in anyone who is immunocompromised.  Some of these
fatal water-borne illnesses include typhoid and cholera.

High infant mortality rates in developing countries, often more than ten-fold
greater than in industrialized countries, are attributed in good part to
inadequate water supply and sanitation.  That some 1.5 billion people are
estimated to lack reasonable access to safe water led the United Nations on
10 Nov 1980 to inaugurate the International Drinking Water and Sanitation
Decade.

It is frequently assumed that the only cause of malnutrition is a failure to
consume an adequate diet because of the unavailability of food.  This
unwarranted assumption may result in overlooking the primary factor
responsible in many cases of malnutrition.  Poverty, famine, ignorance, lack
of money to buy food, poor dietary habits, and infectious diseases lead to
widespread malnutrition in some population groups, even in the presence of an
apparently adequate food supply.  Obesity is frequently due to malnutrition.

Typhus does not equal typhoid, of course, but it is common to confuse the two
diseases due to the similarity in their names.  With disruption of usual
water supply and sewage disposal, as would occur under disaster situations of
war, earthquake or hurricane, and concomittant disruption of controls on food
and water, transmission of typhoid fever may occur if there are active cases
or carriers in a displaced population.  There were probably both active cases
and carriers of typhoid at the time and place you became ill.  Efforts to
restore safe drinking water supplies and excreta disposal facilities are more
appropriate than massive typhoid vaccination.  Vaccination of such
populations is generally not recommended.

Occurance of typhoid fever is worldwide.  The number of sporadic cases of
typhoid fever has remained relatively constant in the USA, with fewer than
500 cases annually for several years (compared to 2,484 reported cases in
1950).  With development of sanitary facilities, typhoid fever has been
virtually eliminated from many areas of the USA;  most cases are now imported
from endemic areas.  Strains of the typhoid bacillus bacteria that are
resistant to recommended antiobiotics used in the treatment of typhoid fever
have appeared in several areas of the world.  Multi-resistant strains have
been reported in Asia, the Middle East, and Latin America.

The reservoir of typhoid fever is humans.  Mode of transmission of typhoid
fever is by food and water contaminated by feces and urine of patients and
carriers.  Important vehicles for transmission in some parts of the world
include shellfish taken from sewage-contaminated beds; raw fruits; vegetables
fertilized with human feces (also called nightsoil); contaminated milk and
milk products (usually by the hands of carriers); and missed cases of typhoid
fever.  Flies may infect foods in which the organisms then multiply to
achieve an infective dose.

In endemic areas, typhoid fever is most common in preschool and school aged
children.  The usual case fatality rate from Typhoid fever is about 10% but
that can be reduced to <= 1% with prompt antibiotic therapy.

For more information on these subjects, some excellent sources are:

John M. Last, editor.  "Maxcy-Rosenau Public Health and Preventive Medicine".
Thirteenth edition.  Prentice-Hall/Appleton-Century-Crofts: 1992.  About 2000
pages!

Abram S. Benenson, editor.  "Control of Communicable Diseases in Man".
Fifteenth edition.  Americna Public Health Association, Washington, DC.
1990.  About 530 pages.

Centers for Disease Control & Prevention "Disease Information" hotline.
(404) 332-4555.  Voice Information System.  Can listen to info and/or have it
faxed to you.  Available 24 hours a day using a touch tone phone.  If you
call during normal business hours (Mon. thru Fri., 8am to 4:30pm, Eastern
Standard Time, excluding Federal holidays), you can be transferred to a
CDC professional.  Recommend listening to the messages you are interested
in first, before attempting a transfer of call to a person.  Can get
International traveler's advisories for infectious diseases.  Immunization
info available.  Tons more info available both to the general public and
health care providers.

I hope this is of some help to you, Fred.

Susan Arday
INTERNET:  CCDDCD1.EM.CDC.GOV
Comments: Gated by NETNEWS@AUVM.AMERICAN.EDU