Widal: A century old blood test and its creator

Widal test is commonly used across tropical countries, in an attempt to find out if a person with fever, has typhoid. This popular test is named after its creator, Georges-Fernand-Isidor Widal, a French physician-scientist. While the test is still popular in areas where typhoid fever is a concern, medical texts rather focus on problems with this test. Its creator has not received much of an attention, and so I was overjoyed to find Widal, on a 1958 postage stamp from France.

Medical Science in the times of Widal

Fernand Widal was born in 1862, when germ theory of disease was still new, and we were still in the process of microorganism discovery. Fevers were named after perceptions rather than a cause. For instance, typhoid was believed to be “like typhus”, two very different causes of fever. It was (and often still is) common to confuse it with malaria.

Widal was twenty-two in 1884, when he completed his initial medical education. A German bacteriologist George Gaffky had isolated Salmonella typhi from a patient with typhoid fever in the same year. The organism was then called Eberthella typhosa, after Karl Eberth, another German who had first seen the bacteria under a microscope, only a few years earlier. In 1886, Widal began his research on typhoid, with an aim to develop a vaccine for the disease.

Widal brought laboratory close to bedside

Between 1886-89 Widal proved that typhoid fever is a result of contaminated water. He was also able to show that rats who were repeatedly injected with Salmonella typhi extract become immune to typhoid fever. His best known discovery however remains the Widal test, which he described in 1896. When serum of a person who had typhoid fever, was mixed with suspension of organism – it formed clumps. This did not happen in many other fevers. This was a beginning for diagnostics, we know today as serology. In 1906 same principle was used to create tests for syphilis.

Widal was a clinician, and in later years he moved from typhoid to nephritis to haemolytic anemias. In the process, he brought about a change. He advocated, that clinicians must look at blood, serum, urine, and other body fluids to make a diagnosis. In a way he bridged the gap between medicine and laboratories. Labs were in a nascent stage then, and he got them close to the bedside.

The Widal test

While Widal test was path-breaking, and proved that we develop antibodies in response to infection, soon the test met its fallacies. The antibodies cross-react, and so did Widal test. It was found to be positive in many other infections, as well as non-infectious conditions. Serial changes in Widal titres as disease progressed were often not done. Slowly with improvements in sanitation, typhoid ceased to be a disease of concern in Europe.

Todays medical textbooks suggest getting blood cultures to diagnose typhoid fever. However, getting a blood culture is still difficult across most countries in Asia and Africa, where the disease is common. So this 125 year old test thrives on. Despite scientific advancements, Widal continues to providing us with clues as we try and discover mysteries of fever.

Fernand Widal was a teacher, and also loved to travel and explore. He lived on till 1929, and extensively contributed to medical literature in his times. While, he remains forgotten but for his name associated with the test he discovered.