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"The initial stages resemble closely those of severe influenza. The temperature rises rapidly, often to from 103° to 104° F., with chills, great depression, weakness, pains in the head and limbs. The eruption appears on the fourth or fifth day after the onset and, except in times of epidemic, the diagnosis is extremely difficult in the pre-eruptive stage. As the eruption appears, the fever is apt to rise. The rash usually begins on the shoulders and trunk, extending to the extremities, the backs of the hands and feet, and sometimes to the palms and soles. It becomes more abundant during the subsequent days, but it is seen very rarely on the face and forehead. It is at first composed of pink spots which disappear on pressure, but soon these become purplish, more deeply brownish red, and finally fade into a brown color. ... A symptom of considerable importance, early and rarely missed, is the severe headache which is apt to be more unbearable in this disease than in other acute fevers. . . . When the rash, together with fever and headache, delirium and extreme weakness, is clearly described, typhus is easily recognized; but it must be remembered that the rash in the mild, isolated endemic cases—and especially among children—may be so slight and transient that often it is not noticed at all by the physician unfamiliar with the disease. For this reason, until typhus becomes epidemic, individual cases may often remain unrecognized."
When an attack of typhus is mild it probably is due to the bite of a rat-flea. In human blood rat-typhus virus may be transformed, by ways which bacteriologists have not discovered, into human-typhus virus which in turn is transmitted by lice in a much more virulent form. Professor Zinsser two years ago invented a vaccine to prevent human typhus (TIME, March 13, 1933). Before that, Dr. Rolla Eugene Dyer of the U. S. Public Health Service invented a vaccine to protect humans against rat typhus (TIME, Nov. 7, 1932). Though the mortality rate of typhus under normal circumstances is low, it does run as high as 60% in a severe epidemic. An attack lasts about two weeks, leaves no marked after effects. Though Plague No. 1 is nowhere epidemic at the moment, Professor Zinsser warns: "Typhus is not dead. It will live on for centuries, and it will continue to break into the open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted, and more and more it will be confined, like other savage creatures, in the zoological gardens of controlled diseases. . . .
"In this—unlike most other matters of international interest—the whole world has cooperated against the common enemy. French, Swiss, American, British, German, Brazilian, Japanese, Chinese, Russian and Mexican investigators have worked together, cheered each other on and helped one another in friendly rivalry. . . ."
Today typhus is endemic in the Southeastern U. S., Mexico, Ireland, the Balkans, the Malay States.