The Final Fever

When Leland Stanford junior first came down with the symptoms of typhoid fever in the winter of 1884, his parents fretted but didn’t panic. The boy’s case was mild, doctors said, and typhoid was just one of many infectious diseases endemic among children and adolescents in the 19th century. Most healthy youngsters with the diarrheal bug eventually recovered on their own and developed immunity.

Still, there were grounds for concern. Before the development of modern antibiotics in the late 1940s, typhoid could be a nasty killer with no respect for rank. Queen Victoria’s husband, Albert, died suddenly of the disease in 1861 at the age of 42. During the Boer War, some 13,000 British soldiers succumbed to the food- and water-borne illness, more than all who died in battle. “In the Crimean War it was terrible,” says James Gamble, a Stanford professor of orthopedic surgery who has written several journal articles on 19th-century medicine. “Epidemics would come whenever there were wars, movements of population or even concentrations of people in general.”

Gamble, whose unusual expertise in Victorian maladies grew out of a love for Dickens’ novels, says physicians were pretty good at diagnosing typhoid fever in the late 1800s and could distinguish it from similar febrile diseases such as malaria and typhus. They were less sure about how the disease was transmitted. The typhoid bacillus Salmonella typhi was first observed in 1880, “but whether bacteria caused the condition was still debatable,” Gamble notes. “Some physicians still thought typhoid could be caused by foul air, what they called miasma.”

Today it seems clear that Leland Junior’s fatal illness came from contaminated food or water consumed during his lengthy walkabouts in Turkey or Greece. Leland’s tutor, Herbert Nash, later recalled that the boy was uncharacteristically quiet on the ride home from a sightseeing trip to the ruins of the Temple of Eleusis and complained of a sore throat and headache. Later, on the train to Naples, Leland stretched out on the seat and slept. By the time the Stanfords arrived in Florence about three weeks later, the bacteria had invaded young Leland’s intestinal lining.

Gamble thinks the physicians who attended Leland Junior may have prescribed “balm water”—basically holy water spiked with a little ammonia and orange peel. Nineteenth-century medical textbooks also were big on meat broth and “lavements,” elixirs made of stomach-soothing herbs like chamomile. Aside from those measures and wrapping the feverish boy in ice-cold sheets, there was little doctors could do. “Traveling back then was not like it is now; it was strenuous at best,” Gamble notes. “The trains were primitive. The wagons didn’t have springs; they didn’t have heating or air conditioning. . . . I have a hunch that Leland Stanford Junior’s resistance was low. His body was trying to fight the disease, but the bacteria just got the upper hand.”

These days, typhoid fever kills fewer than 1 percent of patients who receive proper antibiotic treatment. Yet the disease still claims about 600,000 victims each year in developing countries.