by Arthur Allen
The 1914 Serbian typhus epidemic burned itself out after a year, but events in Russia soon created a new opportunity for the disease. The world has never seen the equal of the great typhus epidemic that christened the Russian revolution. Circumstances under which it might be repeated are almost too dreadful to imagine. In late 1917, the Bolsheviks declared an armistice with Germany, and Lenin pulled Russia’s armies back from the front. They returned home hungry, ragged, and full of typhus. The disease was seeded in the civilian population just as the country plunged into a civil war that drew in Russia’s neighbors and enemies. Historical records of the epidemic are sketchy. The Bolshevik regime lacked the resources to track it, and had little interest in revealing the precarious state of its public health to a hostile world. Doctors who treated the disease often died. There were Western witnesses, but back home few believed their stories. Even fewer cared.
The early years of the Russian revolution, a calvary of war, murder, epidemics, and incompetence, were so catastrophic that observers compared the country to Europe in the Middle Ages. The civil war, lasting roughly from 1917 to 1921, was a chaotic clash of armies whose troops often changed sides—the Bolshevik Reds, for example, fought anti-Bolshevik Whites, Ukrainian nationalists, and Poles led by Józef Piłsudski. White armies under various generals fought Communists, Poles, Ukrainians, and ragtag forces of the anarchist Nestor Makhno. Kiev, the Ukrainian capital, was occupied 15 times in three years. Ravaging, unwashed armies and columns of starving, diseased refugees and camp followers spread typhus across the land. Poor military leadership exacerbated the disorder. “A minor setback would precipitate a retreat that snowballed,” one historian has written, “as technical breakdown, the devastated terrain, the weather, the local population, disease, desertion and fear of political reprisals all conspired to destroy the fabric of the retreating force.”
“I do not suppose that there was a single house or flat in the whole of the south of Russia, from Novorossiysk to Moscow, but had had its case of typhus,” wrote a British physician. The implication of this statement, of course, is that all of Russia was lousy. And that was the case, as the writer explained:
Very well, says the reader, it is easy enough to guard against lice; you only need to wash often, take plenty of baths, change your clothes frequently, and avoid dirty places. But all these simple precautions were impossible. There was no fuel to thaw water or heat it for a bath, or to wash clothes in; water-pipes had frozen and burst; few people possessed spare shirts or underclothes, and, as for avoiding crowds, you could not move a step without running the risk of infection.
The worst of the epidemic began in the midst of the Polish-Soviet war of 1919–20. Lenin, Trotsky, and the other leading Communists had turned their attention west with the belief that after crushing the new, bourgeois Polish state, the Red Army could continue on to Germany and beyond, inspiring revolutions across Europe. The Polish leader Piłsudski, who trusted neither the Bolsheviks nor the White armies, in mid-1919 made a secret deal with Lenin that allowed the latter to send several divisions to fight the White forces of General Anton Denikin as they approached Moscow from the south. Denikin’s army was driven off toward the Black Sea while General Alexander Kolchak, the other major White leader, was routed and fled east over the Urals on the trans-Siberian railway amid a phantasmagoria of terror that covered a vast territory in murder, cannibalism, sickness, and debauchery. The vector of trains aided immensely in the spread of lice and typhus. Every town along the railway was overrun with hungry, freezing people who jammed rail carriages and houses to escape and stay warm. Corpses were packed into warehouses or strewn along roads and railways where they were stripped of all valuables. Every soldier’s greatcoat housed visible clusters of the lice, and the insects, dead and living, lay thick as sawdust on the crowded waiting room floors of the stations.
“The sights which I saw . . . and the statistics which I collected were so staggering that, when I afterwards told about them in Europe, my hearers simply shrugged their shoulders and refused to believe me,” a British intelligence officer wrote of the White Army’s flight. Trains were packed full of dead, dying, and sick typhus patients, often without a soul taking care of them. These so-called death trains were not permitted to stop in stations, and corpses were tossed out the window of moving trains “with as little ceremony as the stoker threw out ashes.” Nurses and orderlies robbed the sick and dead. On February 3, 1920, some 20,000 corpses lay unburied in the snow outside the city of Novonikolaevsk.
Not only the Whites suffered. “Comrades,” Lenin told the Congress of People’s Commissars on December 5, 1919, “it is impossible to imagine the dreadful situation in the typhus regions, where the population is broken, weakened, without material resources, where all public life ceases. To this we say, ‘Comrades, we must concentrate everything on this problem. Either the lice will defeat socialism, or socialism will defeat the lice!’” A German Red Cross relief team sent in 1921 gathered unforgettable visions; its members were astonished at the impassivity of the Russians. In the Kazan area, they saw people eating tree bark, acorns and prairie grass, corn stalks, barn sweepings, clay and horse manure. They saw huts full of people, mostly women and children, lying listlessly in unheated rooms awaiting death or muttering and screaming in typhus deliria, towns where a third of the villagers lay on the ground, dead or unconscious, with dogs gnawing at corpses. They collected at least 200 stories of cannibalism and saw graves that “must be guarded because the starving dig the dead up to eat them.” Disease spread through Moscow through scavengers returning after scouring the countryside for coal and flour. The winter was very cold, and no one could wash even if he or she wanted to. Mutual delousing was “the favorite indoor and outdoor sport,” said an American aid worker.
Conditions were particularly awful among communities of poor Jews. The young American doctor Harry Plotz, who had witnessed epidemic typhus in Serbia in 1915, came to Ukraine in June 1920 on behalf of a Jewish relief organization. At a refugee camp in Kiev, typhus patients lay in the mud, crying for bread. Among the 2,000 refugees were pogrom victims limping about with open saber wounds. “Serbia, during its severe typhus epidemic,” wrote Plotz, “never had a sight like this.” The director of the Jewish hospital informed Plotz that of 110,000 Jews in the city, 25,000 had died of typhus over a period of six weeks. “The infected lice are transmitted from person to person and so the disease is rapidly propagated. The morale of the people is low, the desire to keep clean is lost,” Plotz wrote to the Joint Distribution Committee in New York. At the same time, he said, “Jewish communities are loath to follow orders in regard to bathing and delousing . . . for, under the guise of health propaganda, anti-Semitic literature is distributed, and, in the zeal for cleanliness, beards are violently shaved and pogroms occur.”
Typhus would have a transformative effect on Russia. For reasons that may have to do with the immature immune systems of the young, typhus—like viral diseases such as measles and mumps—strikes more severely in older patients; in Russia, it killed more than half of those over 50 whom it sickened, but was only about 1 percent fatal among children. The rural poor, who were more likely to have been exposed as children to typhus, were also less likely to sicken or die. Thus, typhus killed off the aristocratic old guard and the intelligentsia, while sparing, to a greater degree, the peasantry.
This demographic impact of the disease helps explain why Western powers viewed events in Russia less with tender mercy than with fear. Winston Churchill, who had declared that Germany sent Lenin to St. Petersburg in 1917 “the way you might send a vial containing a culture of typhoid or of cholera to be poured into the water supply of a great city,” depicted Russia as a land of “armed hordes smiting not only with bayonet and with cannon, but accompanied and preceded by swarms of typhus-bearing vermin which slay the bodies of men, and political doctrines which destroy the health and even the soul of nations.” The West focused its support on Poland, attempting to create a cordon sanitaire of
guards and delousing stations to keep infected Russians from traveling west. Travelers would be interned, shaved, deloused, and bathed, their clothes exposed to louse-killing chemicals and hot water. Years before communism established the Iron Curtain, the Western powers constructed a curtain of steam. The hospital laboratory at Przemyl became part of the weave.
This takes us back to Weigl and Fleck, whose laboratory was quietly advancing on the problem in these terrible epidemic years. Weigl had been working under Filip Eisenberg for three years in the fortress laboratory in Przemyl when Eisenberg, in late 1917, won a prized professorship at Kraków’s Jagiellonian University, Poland’s oldest institution of higher learning. On his way out, Eisenberg recommended that Weigl take over leadership of the Przemyl lab. His method of inoculating lice had drawn the attention of the authorities. In 1917, Emperor Franz Josef, while touring Przemyl’s defenses, was introduced to the young typhus tamer. Weigl gave the monarch a tour of his laboratory, explaining in detail his method of infecting the lice. “That is quite interesting,” the emperor kept saying. “Truly it is!” Weigl’s aides would chuckle about the visit for years. It was clear that the old emperor had not understood a thing.
Weigl had not been in charge of the laboratory for long when he became ill, an experience that he would use as an important step toward the creation of a typhus vaccine. Accidentally smashing a petri dish, he stuck himself with glass that had been in contact with a container of typhus germs grown in six successive generations of lice. Soon Weigl developed the characteristic rash on his abdomen as well as a high fever, and his blood provided a positive Weil-Felix reaction. His new wife, Zofia Kulikowska Weigl, nursed him through the illness but also conducted experiments on her husband at his request. She placed matchbox-size cages on his body, each containing hundreds of lice, to feed upon his blood in different phases of the illness. One side of each tiny cage had a piece of wire mesh glued over a large oval hole, the mesh sturdy enough to stay in place but fine-grained enough for a louse to feed through. If his blood gave the lice typhus, Weigl reasoned, it would offer new proof that the organism he had been culturing in the lice through anal injections—the same organism with which he had infected himself—was the causative agent of typhus.
From time to time, Weigl emerged from a fitful sleep and jabbered in a psychotic fashion. Zofia had to pretend he was still giving the orders, or he became very angry and could not be calmed down. “His determination to pursue the agent of typhus fever,” said a close aide, “was so dominant that it did not leave him even when he was deeply ill.” The lice fed heavily upon Weigl and after several days they turned bright red and sluggish, and then died. The accidental experiment had been a success. “The lice set upon me during my feverish period,” wrote Weigl, “became thoroughly infected with Rickettsia prowazekii.” This was the best evidence he’d collected to date confirming the identity of the causative agent of typhus.
Weigl was cautious about publishing—he was never one to write up an experiment without repeating it many times, and he didn’t like to mark each baby step in print. Weigl called such research papers “duck shit.” They reminded him, as an outdoorsman, of what the feathered animals left behind while waddling along. In the view of others, Weigl took this publication shyness to extremes. Even as a student, he was always so thrilled to be doing science and excited by his discoveries that he couldn’t be bothered to publish anything, until his superiors threatened to withhold his stipends. But having emerged from his own rite of typhus passage, Weigl published the first exposition on his research methods, a 20-pager with graphics in a German medical publication, Beiträge zur Klinik der Infektionskrankheiten und ur Immunitätsforschung (Clinical contributions to infectious disease and immunity research).
The paper outlined progress in typhus research to date and then explained the many painstaking steps and small technical details of Weigl’s work maintaining R. prowazekii in a colony of lice. Its implications were groundbreaking and immediately obvious to the international research community: for the first time, one could study a stable colony of typhus germs in vivo where there was neither a typhus epidemic nor human typhus patients.
World War I ended with the dissolution of the great empires of Europe and the emergence of an independent Polish state for the first time since the 18th century. Polish independence made Weigl’s struggle with the disease even more meaningful to him, for something in the happy childhood he experienced with his Polish stepfather had converted Weigl into a strong Polish patriot. He and a friend were discussing the famous scientist Marie Skłodowska-Curie once over drinks, and Weigl criticized Curie for raising her daughters as Frenchwomen, with no Polish identity at all. “Look at me, I’m a full-blooded German,” Weigl said, “but I identified with Poland when it wasn’t even on the map, and I’ll always be Polish.”
Health disasters were among the greatest challenges that Poland faced in its first years of independence. The 28 million new citizens of the country underwent terrible hardships between 1914 and 1920 as armies clawed for control of their lands. Cities and towns were occupied, pillaged, and razed repeatedly. Hundreds of thousands starved to death. Millions were homeless. Industry was destroyed, agriculture in chaos. Pogroms ruined hundreds of Jewish towns. As disbanded White and Ukrainian armies and refugees fled into Poland, disease spread. According to the Polish government, the country suffered 673,000 cases of typhus, with 141,500 deaths, in 1918. Many of the victims were Russian POWs. At the armistice of 1918, there were 2 million Russians in German captivity, many of them on Polish territory. When Poland went to war with the Bolsheviks in February 1919, the repatriation of the Russian POWs stopped. American, British, Swedish, and International Red Cross relief teams arrived to try to help the Poles control the epidemic. Herbert Hoover, whom Wilson had appointed as his humanitarian czar for postwar Europe, directed Colonel Harry Gilchrist, a veteran of World War I campaigns in France, to offer his antityphus services to the Polish government. The Americans found appalling conditions in Poland. In teeming POW and refugee camps near Przemyl, the new public health authorities were unable to provide decent conditions for the sick captives. Men slept on the mud in poorly built huts with broken windows. Prisoners who arrived at one camp after traveling for five days in November 1919 grabbed a dead horse lying by the side of the road and tried to eat its raw carcass. A typhus epidemic that began that month claimed 247 of the 1,100 prisoners there.
An army could forcibly delouse POWs, if it had the facilities, but it was not easy to persuade the “great unwashed” to submit to delousing. In some of the colder, poorer regions of Poland, winter bathing was still viewed with suspicion, though Jewish men and women had regular recourse to the ritual bath or mikveh that traditionally is attached to every Orthodox synagogue. Perhaps because lice were an inevitable part of life throughout most of human history, some traditions held that one’s lice protected one from disease; the great 18th-century biologist Linnaeus subscribed to this theory. In eastern Poland, the uneducated—Pole and Jew alike—were said to believe that lice were necessary body armor. But the new health authorities of Poland, and their Western allies, were determined to drive away pests and pestilent ideas. The Americans sent six delousing trains, each capable of cleaning 1,000 refugees per day, to the Polish–Russian border and other areas. The mobile plants consisted of a water tanker with hoses and tents. Children were always the first to volunteer for a bath. “If the older people were as enthusiastic as these children, typhus would no longer be a dread in Poland,” Gilchrist wrote. Town officials devised a plan requiring citizens to show a bath ticket in order to buy bread and potatoes. Forged tickets soon appeared. Over time, however, some warmed to the American cleaning teams. In the Illustrated Daily Courier of Kraków, an ad appeared on October 30, 1919, describing the appearance of American baths in central Lwów: “on a great square where many institutions are found . . . a passer-by sees an uncommon sight: By one entrance he sees people dirty as Satan; by other doors they come out clean lik
e angels. . . . Oh magic bath! Come quickly to Kraków, for you are more necessary here than anywhere else!”
Western scientists were ready to believe the worst about the hygiene of Eastern European Jews, but came away with mixed opinions. “The Jews were said to be less cleanly than the Christians, and from what I saw of them I should say that this was true,” the British epidemiologist E. W. Goodall wrote in 1920. But in the same publication, he attributed the lower mortality rate of Jews in one district to their greater access to medical care. He concluded that although Jews in some places were more likely to get typhus, “it is doubtful, in my opinion, that they so suffered because they were Jews: the more probable reason is because they were more densely crowded together.”
Several of the medical teams traveled to Lwów, which was beginning to gain recognition as a center of typhus research. Weigl had started work on his typhus vaccine. By 1921, the year he was appointed full professor in the Department of General Biology at Lwów University, he had something to show for it.
CHAPTER TWO
CITY ON THE EDGE OF TIME
Weigl’s appointment was an unusual honor for a 38-year-old in the cramped, graying world of Polish academia. Weigl brought along Fleck and a few other members of his team from Przemyl, and they settled into the department’s headquarters on the basement floor of a former Trinitarian monastery at 4 St. Nicholas Street, near the center of the city. Weigl’s team was part of a dynamic group of public health scientists, many of them officers in the Polish military. They put themselves at the service of the state by creating a brand-new health system, which offered universal insurance to its citizens and set about battling the diseases that had plagued the country over the ages. The bacteriologist Ludwik Rajchman was at the forefront of this effort. He led international efforts to fight typhus in Poland and the East, and in 1921 took charge of the new, Geneva-based League of Nations Health Organization, the forerunner of the World Health Organization. Rajchman, an assimilated Jew of left-wing tendencies, persuaded a cousin, the hematologist Ludwik Hirszfeld, to head the Polish National Institute of Hygiene, which the hyperactive Rajchman also had organized. The health agency, known by its Polish initials PZH, established branches throughout the country and set to work rebuilding the country’s shattered public health infrastructure—or in some cases, creating it from scratch. The worst typhus epidemics were in the southeast, in the region south of Lwów. During the end of the Habsburg Empire and the beginning of the Polish state, military scientists like Weigl worked closely with PZH epidemiologists to sort out the causes of the disease and crush it. Soon after Weigl moved to Lwów, Hirszfeld invited him to PZH headquarters in Warsaw to demonstrate his louse-inoculation techniques to British, French, German, and American scientists who were studying the disease in Poland.