Alice in Typhoidland

The Past and Present of Typhoid

https://www.youtube.com/embed/l3-hyufYnlg

Glide with us on a murky ride as we journey down the sewer hole into Oxford's underside ...

Join Alice Liddell (Alice in Wonderland) on a tour of the past and present of typhoid control.

Discover how Victorian doctors and scientists helped make typhoid visible and developed the first typhoid vaccines.
Learn about the current challenges of typhoid across the world and what researchers in Oxford are doing to tackle it.

There is much to see in Typhoidland.

Typhoid is an ancient disease.

It is caused by the bacterium Salmonella enterica serovar Typhi (S.Typhi) and spreads in contaminated water, food, and milk.

For thousands of years, typhoid was an invisible threat to both princes and paupers.

It killed up to one in five of its victims and made many others very unwell.

It was only after 1800 that new clinical, statistical, and bacteriological methods helped turn typhoid into a clearly defined and preventable disease.

Alice in Typhoidland Alice holding teacup

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Sanitation reform: The Two Henrys

Dean Henry Liddell, father of Alice Liddell (from the Alice books), joined forces with this friend Sir Henry Acland to campaign for sanitary reform in Oxford.

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Sanitation and typhoid in Oxford

Poor drainage and sewers in 1850s Oxford meant that low-lying parts areas were described as "a swamp converted into a cesspool". By 1900 changes in water and sanitation structures had transformed the city.

The Walrus and the Carpenter speaking to the Oysters, as portrayed by illustrator John Tenniel.

Fast Fact

Oysters — "eaten every one"

Because many oysters were grown in sewage-contaminated water, they could also transmit typhoid and repeatedly caused mass outbreaks.

Fast Fact

Last major UK typhoid outbreak

Typhoid can be transmitted in foodstuffs like fruit, leafy vegetables, milk, shellfish, and meat. In 1964 tinned meat from Argentina contaminated with untreated river water caused Britain's last major typhoid outbreak.

Growing knowledge about typhoid and its transmission led to significant improvements in disease control.

Victorian reformers like Sir Henry Acland and Dean Henry Liddell used the spectre of typhoid to campaign for improved sewage disposal and safe drinking water.

By 1900 pasteurising milk and chlorinating water had also proved effective in combatting typhoid.

Another powerful way to prevent typhoid was developed in 1896 when German and British researchers used killed typhoid bacteria to develop the first generation of typhoid vaccines.

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How do vaccines work?

To understand how vaccines work, it helps to know how the immune system works. The Oxford Vaccine Group explains how vaccines enable the body to make the right sort of antibodies to fight a particular disease.

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Deaths from typhoid and enteric fever

Discover how typhoid and enteric fever affected Oxford from 1872-1901 and the impact of new sewer and water systems on disease incidence.

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The birth of bacteriology

Bacteriologists used microscopes to identify the causes of many diseases. In Oxford Sir Henry Acland was an important convert to bacteriology, although Oxford's Medical Officer of Health continued to believe that poisons were responsible for typhoid.

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Surgical probes

Victorian physicians like Sir Henry Acland used surgical probes like these during autopsies to identify the causes of death and disease.

Early vaccines helped control typhoid in war and emergency zones.

However, popular opinion about their safety was divided.

In Britain typhoid vaccines’ first rollout was marred by side effects and logistics problems. Improved vaccines were reintroduced during WWI.

Despite protests from a small but vocal group of anti-vaccine activists, prominent physicians helped ensure voluntary mass-vaccination.

Most Britons now encounter typhoid vaccines when they are travelling abroad but newer vaccines also help protect populations without access to safe water and health systems.

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Hypodermic syringes

Vaccination has changed considerably since 1796 when smallpox vaccinators rubbed cowpox into gashes made by a lancet. Hypodermic syringes, including a hollow, detachable needle, became popular from 1853 onwards and allowed doctors to administer measured doses of drugs and vaccines.

Boer War - an army medical officer pulling down the fly of a marquee in which lie soldiers with enteric fever. Credit: A.S. hartrick c.1900

Fast Fact

Vaccines at war

1896 saw the first typhoid vaccine developed by bacteriologists Wright, Pfeiffer and Kolle, although public trust in the vaccine was low. Alexander Fleming, who discovered penicillin, was Wright's student.

First World War Oxford volunteers marching past the Sheldonian.

Fast Fact

Anti-vaccine protests and WWI

Despite fierce opposition from anti-vaccine activists, widespread vaccine promotion resulted in the vaccination of about 80% of British troops in France by December 1914.

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Opacity tubes

The first typhoid vaccines used solutions of killed bacteria to trigger an immune response. Laboratories used machines like this to compare the cloudiness (turbidity) of the vaccine solution to a standardised tube and calculate the number of killed bacteria in each batch.

Despite over 150 years of control efforts, typhoid still infects over 11,000,000 people of whom over 100,000 die every year.

Worryingly, typhoid is also becoming resistant to the antibiotics used to treat it.

A current mass outbreak in Pakistan is untreatable with all but one of the affordable oral antibiotics.

Tested in Oxford in 2017, the new typhoid conjugate vaccine (TCV) and increasing global access to safe water and health systems are crucial ways to tackle typhoid.

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Typhoid swallowers

In 2017 about 100 participants in Oxford drank live typhoid bacteria to test how well a new vaccine worked. Here is the story of two of the trial volunteers. Shortlisted for Bristol Science Film Festival 2020.

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From lancets to disposable syringes

The first smallpox vaccinators used a lancet to create a cut; from 1853 onwards, hypodermic syringes became popular. Disposable plastic syringes, introduced in 1956, significantly reduced infection risks.

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Treating with antibiotics

Antibiotics play an important role in treating typhoid and curing healthy carriers. They work by either killing bacteria or stopping them from reproducing. Up to the 1980s, antibiotics were effective against typhoid; since then, typhoid has built resistance against many of the antibiotics used to treat and control it.

Fast Fact

New hope for control

Typhoid conjugate vaccines (TCVs) offer new hope for typhoid control. The only currently licensed TCV was tested in Oxford in 2017. In Pakistan it's used to vaccinate children under two and only needs one dose to achieve a protection rate of over 81%, making it ideal for areas with limited access to safe water and health care.

The Walrus and the Carpenter speaking to the Oysters, as portrayed by illustrator John Tenniel.

Wellcome Collection - watercolour drawing of two portions of the intestines illustrating the morbid effects of a case of dysenter with typhoid fever.

Watercolour drawing of two portions of the intestines, illustrating the morbid effects of a case of dysentery with typhoid fever.

Boer War (1899-1902) medical officer tending to soldiers with enteric fever.

First World War Oxford volunteers marching past the Sheldonian. Despite fierce opposition from anti-vaccine activists, widespread vaccine promotion meant that about 80% of British troops in France were vaccinated by December 1914.