Patients can be successfully treated with antibiotics, but it was once a major killer. The first scientifically reliable accounts of the disease come from 15th-century Europe, though it has probably been around much longer.
Symptoms include severe headache and muscle pain, fever, delirium and a characteristic rash. Several major outbreaks described as ‘plagues’ by chroniclers were, in fact, typhus.
The cause of epidemic typhus is Rickettsia prowazekii, bacteria usually transmitted by body lice. It thrives in overcrowded places where sanitation is poor and immune systems are weakened by hunger. Outbreaks were common in armies well into the 20th century, and it often killed more soldiers than combat, as in Napoleon’s 1812 retreat from Moscow. The last outbreaks of gaol fever to kill significant numbers of Europeans were in Hitler’s concentration camps.
It commonly occurred in the appalling conditions of Britain’s prisons before Victorian reformers cleaned them up, hence the name ‘gaol fever’. Being held in prison before trial could be tantamount to a sentence of death, and more died of goal fever in the 1700s than were executed. In a particularly notorious case, prisoners from Ilchester gaol brought to Taunton assizes in 1730 caused an outbreak that killed the judge, several court officials and hundreds of others.