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April 8, 1950

BRILL'S DISEASE: I. Clinical and Laboratory Diagnosis

Author Affiliations

Boston; New York; Brooklyn; Philadelphia; Boston

From the Department of Public Health Bacteriology, Harvard University School of Public Health (Drs. Murray and Snyder) and the Beth Israel Hospital, Boston (Dr. Cohen); the Mount Sinai Hospital, New York (Drs. Baehr and Shwartzman); the Jewish Hospital of Brooklyn (Drs. Mandelbaum and Rosenthal), and the Jewish Hospital, Philadelphia (Drs. Doane and Weiss).

JAMA. 1950;142(14):1059-1066. doi:10.1001/jama.1950.02910320021006

Brill's disease has been defined as a typhus-like illness occurring chiefly among the immigrant populations of the Northeastern coastal cities of the United States.1 In this paper and one which is to follow2 attention is directed to recent clinical and laboratory studies of Brill's disease which emphasize that: (1) the present diagnosistic criteria must be revised; (2) the reported incidence of Brill's disease may be expected to increase; (3) Brill's disease may indeed be important in initiating new epidemics of louse-borne typhus, and (4) the etiologic agent, isolated from 7 patients, is indistinguishable from that of classic epidemic typhus.

HISTORY  During an epidemic of typhoid in Mount Sinai Hospital, New York, in 1896 Nathan Brill became convinced of the specificity of the Widal test, which had just been described. Brill's curiosity was aroused when he observed sporadic cases of an atypical typhoid-like disease in which the Widal reactions

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