During the First World War the German army and above all the German people remained almost totally protected from larger epidemics. The reason for this astounding fact is to be found in the fact that even before the war, thanks primarily to the scientific work of mainly German researchers, especially Robert Koch (whose 100th birthday we already celebrated on December 11, 1943) and his students, who discovered and brought to public attention the most important disease carriers, their means of transmission and the possible ways to combat them. During the campaign it developed, thanks to the scientific work which was conducted in the field examinaing stations as well as in the epidemiological branch, an additional series of discoveries was made in the area of causative agents of disease and their modes of transmission. So it was that Paul Uhlenhuth, the recipient of the first Behring Prize, discovered the carrier which occurs with jaundice, namely the often fatal Weil disease (a waterborne spirochete which is infected through rat feces and carried to humans in the hot summer months.) The Vohlynian disease again gave us trouble in southern France where it afflicted soldiers who had been bathing in rivers even though they had been warned by the civilian population that to bathe there in the hot season would make them sick. Also it was established once and for all that humans were infected by the classical typhus as well as the Vohlynian or five-day fever only through the feces of infested clothes lice. Consequently an urgent need to construct appropriate delousing facilities was recognised to work as a filter and effectively prevent the spreading of this wartime disease into the territory of the Reich. While studying typhus, many a scientist--for instance, the Marburg student of Emil von Behring, Paul Roemer--came to his death. The recognition that European relapsing fever is also transmitted by lice and can be treated with Salvarsan, which is also effective against syphilis, saved the lives of thousands of Turkish soldiers in the Dardanelles campaign. They were treated by our present tropical hygienist in the military medical academy, surgeon general Prof. Dr. Rodenwaldt.

During World War 1, a number of germs were discovered in the feces as well as the soil which (if transmitted into open wounds) would cause gasodemia and other equally serious wound infections. Without any doubt, war has here furthered the bacteriological research as well. The new discoveries were of utmost importance for the armies.

However, there still were epidemics and illnesses which one could not master. Foremost among them was the bacillus dysentery which must be regarded as the "primary war epidemic of the world war." This disease increased rather than decreased and retained its high mortality rate. Even amoebic dysentery caused considerable casualties which were so great among the English at Gallipoli that they contributed to the abandonment of this Churchill-inspired campaign.

Typhus and dysentery are the diseases which give us the most trouble in this war in addition to the venereal diseases and malaria. In peace time, we did not have to fear the outbreak of major epidemics. But, the moment we crossed the borders with our armies, we entered areas in which (as for example in Poland) there was little trace of a prepared peacetime practice of defensive hygiene. It was only there that the first contact with the disease pathogens was made. And with the increase in the number of people who remained healthy, but who carried the germs, the introduction of diseases into the Reich was assured.

Therefore, above anything else we must prevent any contact with foreign disease material through hygienic and prophylactic measures. Above all else, we must inoculate our soldiers and all medical personnel as widely as possible against all likely disease germs so that as far as possible, no casualties from illness will occur. How many millions of lives of recently wounded soldiers have been saved through prophylactic serum inoculation against tetanus cannot be measured. Today we even have vaccines which (for example, upon conscription into the Wehrmacht) could probably give lifelong immunity against tetanus. Also, in the development of vaccines against typhus and against dysentery this war has once again brought great progress. Vaccines against typhus from lice intestines, from chicken eggs, from rabbit lungs and from mice lungs are produced in gigantic quantities in large, newly constructed institutes, for example, in Cracow and Lemberg (Lvov). The inoculated cannot be protected completely against contracting the disease but they are protected against death from the typhus. The other kinds of typhus which are occasionally observed in the south of Greece, such as the so-called "murine" typhus which is carried by the feces of rats including their other parasites, or the so-called "tick typhus" from the brown dog tick are, despite the high fever, far less harmful to people than the "classical" louseborne typhus. The vaccinations against the classic typhus have been effective against the rare rat typhus but not against the tick typhus. Here one can protect oneself best by prohibiting troops in tick fever infested areas from keeping dogs, which can be carriers of other tropical diseases as well.

German hygienic science is also in the process of developing effective vaccines against dysentery. To control dysentery it is of the utmost importance to make human waste products harmless and to not give flies any opportunity to carry dysentery bacillus from feces to food. This is an especially important consideration in the construction of latrines. The East African campaign taught us in this regard about the very useful smoke latrines, the present war about the drill hole latrines which makes the transfer of disease from feces practically impossible.17

Germany at War's End--the Wild West and the Hordes of Genghis Khan

Although great progress had been made in military medicine as well as medicine in general between the American Civil War and World War 2, what use was all that amidst the chaos which reigned on the territory of the loser, particularly in Eastern Europe, near the end of the war? Should anyone be surprised that after years of intense bombardment of civilian targets, to the extent that journalists agreed that Germany's cities looked like the face of the moon, the conditions to which people had been reduced were comparable to those from which the world had supposedly advanced in only eighty years?

Perhaps the best discussion of conditions at the end of World War 2 in Germany is by John E. Gordon, M.D., Ph.D., Professor of Preventive Medicine and Epidemiology at the Harvard University School of Public Health. I hesitate to give so many details about an author but it is probably necessary to establish the fact that the excerpts which follow are not from someone who can be easily branded as another pro-German revisionist. The passages which follow were published in 1948 by the American Association for the Advancement of Science:18

(5) Foreigners in the Rhineland. . . .

The whole area seethed with foreign peoples, conscript laborers moving this way and that and in all directions, hoping to reach their homes, in search of food, seeking shelter. Most of the typhus was within this group and they carried the disease with them. They moved along the highways and in country lanes--now a dozen Roumanians pulling a cart loaded with their remaining belongings; here a little band of Frenchmen working their way toward France, there some Netherlanders, or perhaps Belgians; and everywhere, the varied nationalities of the East--Ukrainians, Poles, Czechs, Russians. They moved mostly on foot, halted, then gathered in great camps of sometimes 15,000 or more, extemporized, of primitive sanitation, crowded, and with all too little sense of order or cleanliness.

These were the people where typhus predominated, more than a half million of them in the Rhineland, wearied with the war, undernourished, poorly clothed and long inured to sanitary underprivilege and low level hygiene. Add to this shifting population the hundreds of released political prisoners, often heavily infected with typhus but happily far fewer in numbers; the German refugees, first moving ahead of our troops and then sifting back to their homes through the American lines. Rarely if ever has a situation existed so conducive to the spread of typhus.

Typhus fever in a stable population is bad enough. It has demonstrated its potentialities in both war and peace. The Rhineland in those days of March, 1945, could scarcely be believed by those who saw it--it is beyond the appreciation of those who did not. It was Wild West, the hordes of Genghis Khan, the Klondike gold rush, and Napoleon's retreat from Moscow all rolled up into one. Such was the typhus problem in the Rhineland.

The Epidemiologic Situation

The great assault of the Rhine River got under way on March 24, the British 21st Army Group and the U. S. Ninth Army to the north, the First and Third Armies in the center, and somewhat later the U. S. Seventh Army and the First French Army to the South. All found typhus fever; the British scarcely any, the Ninth some, the First and Third a great deal, while in the south the U. S. Seventh and the First French Armies again encountered relatively little.

The first really serious condition appeared when Buchenwald concentration camp was occupied by the Third Army on April 12th. The British soon uncovered Belsen camp, with still more typhus and misery. Then followed in order Dachau, Flossenburg and finally Mauthausen, all with hundreds of cases of typhus fever and sometimes thousands.

These concentration camps with their political prisoners and their typhus fever would have been problem enough. Added to the situation were millions of conscript laborers suddenly released from employment and from camps that were many times typhus infested. They scattered throughout the country. Many were gathered in large improvised camps. They spread typhus widely...

. . . Germany in the spring months of April and May was an astounding sight, a mixture of humanity traveling this way and that, homeless, often hungry and carrying typhus with them.

Special Epidemiological Problems

The outbreaks in concentration camps and prisons made up the great bulk of typhus infection encountered in Germany. Each presented an individual epidemiologic problem. That of Dachau is illustrative. The Dachau camp, located in Bavaria about 5 kilometers north of Munich, was one of the largest and certainly one of the most notorious of the Nazi installations housing political prisoners. It was liberated by units of the U. S. Seventh Army on May 1, 1945.

An estimated 35,000-40,000 prisoners were found in the camp, living under conditions bad even for a German camp of this kind and worse than any other that came into American hands. Extreme filthiness, louse infestation and overcrowding prevailed throughout the camp buildings. Several car-loads of human bodies were found packed in box cars in the railroad yards adjacent to the camp, the vestiges of a shipment of prisoners from camps farther north who were transferred to Dachau in the late days of the war to escape the advancing United States troops.

The number of patients with typhus fever at the time the camp was first occupied will never be known. Days passed before a census of patients could be accomplished. Several hundreds were found in the prison hospital, but their number was small compared with the patients who continued to live with their comrades in the camp barracks, bedridden and unattended, lying in bunks 4 tiers high with 2 and sometimes 3 men to a narrow shelf-like bed; the sick and the well; crowded beyond all description; reeking with filth and neglect--and everywhere the smell of death.

During the first few days little more could be done with the limited staff that was available than make the rounds of the barracks, pulling out the dead and the dying...

Available records failed to demonstrate how many of the 4,032 patients of the Dachau epidemic were actually ill with typhus at the time the camp came under American jurisdiction, how many developed the disease within the succeeding 14-day incubation period, . . .

Even the appreciable figures cited fail to include all who contracted typhus fever in Dachau concentration camp. Freed from the sort of existence they had been living, it was no wonder that those strong enough should attempt to escape. Many did, and scattered widely through the nearby country, especially to the region south of Munich. Some were actually in the clinical stages of typhus fever and many were incubating the disease. They were later found with typhus fever in other areas.

The camp was promptly quarantined. Hospitals were moved in to augment the small prison hospital. Case finding teams initiated control work through survey of the surrounding area for former inmates developing typhus after leaving. The dusting of prisoners with DDT powder was started May 3, 1945, and completed May 8.

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