primary contemporary associates included Drs. Edward Francis, Alice Evans, Margaret
Pittman, James P. Leake, and Sara Branham. For the accomplishments of these
physicians and scientists, the reader is referred to Williams (1), Harden (1), and NIAID
Intramural Contributions (1). Charles Armstrong began his career in the Hygienic
Laboratory primarily with several field epidemiological studies.
Typhus Fever on the San Juan Indian Reservation, 1920and 1921 (2).
The organism, Rickettsia provazekii, causes epidemic typhus (3). Rickettsia are
small, obligate (need living cells to grow), intracellular, gram negative (take basic dyes)
pathogens, held back by the usual bacterial filters, and readily seen under the microscope
when prepared by special stains. They require an insect vector to infect their usual hosts.
Epidemic typhus is spread to humans by the feces of infected body lice, either by rubbing
into the abraded skin or by aerosol into mucous membranes. Lice infect the human
population by louse transfer from person to person. Typhus epidemics have been
recognized for millennia, and usually occur with major population upheavals such as
wars, famine, floods, and other natural disasters. Hans Zinsser’s book, Rats, Lice and
History (4), provides a historical perspective of the human worldwide experience with
typhus and bubonic plague. Typhus is a serious febrile disease associated with confusion,
characteristic rash that spreads from the trunk to the extremities, and high mortality if
untreated. The advent of the tetracycline and chloramphenicol antibiotics provided highly
effective treatment and resulted in a marked reduction of mortality and morbidity.
The classical methods of prevention and control involved the destruction of
bodies and clothing infested lice by rather cumbersome and labor intensive methods.