Summary and Conclusions
Conditions in Western Europe in many respects favored a
much greater spread of typhus fever than actually occurred. Germany was in
chaos. The destruction of whole cities and the path left by advancing
armies produced a disruption of living conditions contributing to the
spread of the disease. Sanitation was low grade, public utilities were
seriously disrupted, food supply and food distribution were poor, housing
was inadequate and order and discipline were everywhere lacking. Still
more important, a shifting of populations was occurring such as few
countries and few times have experienced.
Native Germans, dislodged from their homes and often
moving long distances to escape the enemy, were finding their way back to
their native lands. The roads, the countryside, were full of released
German prisoners of war who lacked transportation and were their to their
homes on foot. . . .
Two important factors served to limit the extent of the
outbreak. The most significant was the time of the year that allied troops
entered Germany. Had this been December instead of March, as would have
happened except for disrupted military plans, the problem would have been
much more serious. Von Rundstedt's Battle of the Bulge, although of
serious import militarily, had the favorable aspect of postponing contact
with typhus until the spring months.
Spring brought a lower potential of louse infestation,
it permitted life outdoors instead of crowding within existing
habitations, and the movement of displaced persons and refugees was
facilitated, with consequent greater dispersal. Dispersal of course, had
advantages and disadvantages. It tended to disseminate infection
broadly--it limited concentrated outbreaks.
Early repatriation of all Russian nationals, both
prisoners of war and conscripted labor, was undertaken in May and
completed in June. A large part of available American transport was turned
to this end, with the result that thousands of Russians were repatriated
every day. They were the population groups with the heaviest incidence of
typhus.
Under any interpretation of governing circumstances,
much credit must be given to the efficiency of recently developed methods
of typhus control. The value of delousing through dusting with DDT, and
the usefulness of typhus vaccine were tried and tested on a scale greater
than ever before and under conditions epidemiologically more conducive to
extensive and continued spread of the disease. The results attained in the
Naples epidemic were confirmed and extended.
No single factor contributed more to the satisfactory
end of the outbreak than that never in the course of the epidemic were the
fundamental supplies of DDT powder and vaccine lacking. Occasional
difficulties arose in local distribution, but the supply system was such
and the stock piles so great that they were promptly remedied.
The middle of July saw Western Europe return to a
satisfactory situation of low grade typhus endemicity.18
Because of their overwhelming air power, the Western
Allies had been able to wreak enormous havoc upon Germany, particularly her
cities, long before any ground troops were engaged near those cities. Cities
which had taken a thousand years to build were destroyed in a few hours long
before a single Allied tank or infantryman appeared.
In a recent best-selling book by the first man to break
the sound barrier entitled Yeager: An Autobiography the author described how
in the Fall of 1944 his fighter group was
...assigned an area fifty miles by fifty miles and
ordered to strafe anything that moved. . . . We weren't asked how we felt
zapping people. It was a miserable, dirty mission, but we all took off on
time and did it. . . . We were ordered to commit an atrocity, pure and
simple, but the brass who approved this action probably felt justified
because wartime Germany wasn't easily divided between 'innocent civilians'
and its military machine. The farmer tilling his potato field might have
been feeding German troops.19
This occurred, incidentally, at a time when there was no
reasonable doubt about the eventual outcome of the war nor any danger to the
United States. The farmer tilling his potato field might have also been
feeding concentration camp inmates or prisoners of war--how could one
possibly tell the difference? How can Americans condemn Germans for not
giving enough food to prisoners when they themselves were deliberately
killing farmers growing potatoes in their fields?
One can well imagine that during the last months of the
war--when entire German cities were destroyed almost daily--many German
medical or supply personnel, who would have otherwise gone to perform
assigned duties at concentration camps, simply felt that Germany's enemies
could fend for themselves. How can anyone realistically blame them? How can
anyone imagine that they would risk their lives under almost constant air
attack to get to the camps, there to face death from disease and, sooner or
later, the vindictiveness of the inmates and the liberators who had a major
part, at the very least, in bringing about the atrocious conditions in the
first place?
As far as conditions essential for the health and survival
of large populations are concerned, the clock had been turned back--in some
respects, as far back as the Middle Ages. By the Winter and early Spring of
1945 in Germany, tens of millions of people were fleeing into an area so
small that, even in the best of times, enough food could not be produced to
sustain the normal population. Casualties were in the millions. All major
cities were in ruins. The fact that Germans facing extinction in these
circumstances neglected the health and nutrition of many of their most
bitter enemies in concentration camps should not be at all surprising.
Typhus in Eastern Europe
Typhus in recent centuries has afflicted primarily the
countries of Eastern Europe during wartime, especially during cold weather
when soldiers and civilians are least inclined to endure the brief
discomfort of bathing or cleaning their clothing. The misery that arises
from such personal behavior is, of course, compounded by the social upheaval
and movement of large masses of people that war tends to bring with it.
The misery is probably unimaginable to a Western European
or an American. Some idea may be derived, however, from the following text
from the same British doctor who described the makeshift delousing tunnels:20
Predisposing Conditions
Louse-borne typhus fever is an acute infectious disease
lasting from twelve to sixteen days and characterized by a continued
temperature, a generalized maculopapular rash which may become
haemorrhagic, severe toxaemia, and marked nervous manifestations. The
disease is carried by lice and spreads with extreme rapidity especially
through a badly nourished population. Thus in Russia during the period
1919 to 1922 the estimated number of cases was 10,000,000, with 3,000,000
deaths, in a population of 120,000,000. These are stupendous figures.
Their scale can be realized to some extent by recalling that in the
much-described typhus epidemic in London in 1856 only 1,062 cases were
recorded as treated in the London Fever Hospital out of a population of
3,000,000 whereas in Russia in the year 1921 alone there were 4,000,000
cases in a population of 120,000,000. These figures can, of course, only
be approximate, as many cases diagnosed as typhus were in reality
instances of relapsing fever; on the other hand a vast number of cases of
typhus were never admitted to hospital and so remained unrecorded. Of the
cases admitted to hospital very many were never notified by the Russian
medical officers owing to pressure of work. So uncertain were the
statements that when we went into a new district to survey the amount of
typhus present we found it more useful to base our estimate on the number
of women with recently shaved heads seen in the streets, than to rely upon
notification figures. All cases on admission to hospital for typhus were
closely shaved and consequently it was possible to sit in a cafe and
determine the proportion of women with closely cropped heads to the
general population and so to estimate roughly the amount of typhus in the
region.
Epidemic typhus fever, is, classically, associated with
famine and overcrowding, but there is a third factor which, to my mind, is
perhaps of even greater importance, namely, widespread movements of
military or civilian populations bringing non-immunes into a district
where the disease is endemic or carrying the disease into a typhus-free
region. A third possibility is that such movements may introduce into an
endemic region either a new strain of the disease or one of enhanced
virulence. The first mode of infection I saw well demonstrated in the
epidemic in North China two years ago which was due to the introduction of
masses of non-immunes with the Army into areas where the disease was
endemic. The second method occurred on the return of Polish prisoners of
war to Poland from Siberia in 1919-1922. These men, women and children had
been heavily infected with typhus in Russia, and passed into Poland at the
rate of tens of thousands a day, going to regions in which the disease
either was already endemic or did not exist previously; in both cases
widespread epidemics resulted.
Apart from mass movements of the kinds instanced above,
a striking feature of epidemics is the amount of local movements of the
population that they initiate. Once typhus is really established in a
district, fear of contracting the disease, combined with terror of the
appearance and acts of delirious patients, is soon widespread. Transport
of food and fuel quickly breaks down, starvation threatens, the sick are
abandoned, often in the roads, the houses are deserted and the terrified
population flees from the infected area into a neighboring village or
another part of the town as the case may be, carrying the disease with
them. Too often the hospital staffs may flee with the others. 20
But there is even more horror. In Russia during the early
1920's conditions had deteriorated so badly that even cannibalism had become
widespread. Mothers murdered and then ate their children; adults murdered
and then ate their parents. 26 people who had resorted to cannibalism and 7
others who had sold human flesh were identified by one Russian doctor alone
on the basis of his own personal observations. In the town of Samara, the
entire mental hospital was set aside for people who had committed
cannibalism. The German doctor who reported such incidents in 1923 wrote
that such acts were not unusual and attributed the practice to the
psychological deterioration of people suffering from protracted hunger and
disease. One mother, for example, had gone into a rage as her murdered child
was taken away from her and had cried out that it was her child, she had
borne it, and that no one had the right to eat it except for her.
Interestingly enough, the German doctor thought it significant that the
people who had committed such acts were all native Russians from the lower
social strata and that "there were no German colonists, no Jews and no
members of any other nationality among them."21
As I write this, there are reports in the press of mass
starvation in Palestinian refugee camps in Lebanon. A UN relief official has
just explained that the people are already eating cats, dogs and rats but
that they have not yet resorted to cannibalism. Her remarks suggest that to
people who deal with famine, incidents of cannibalism are not unusual.
One hesitates to write about such behavior for fear of
sensationalizing an already morbid subject, but it is probably necessary to
convey the depths to which human beings can be brought by the conditions
which must have existed, at least in some places, in Germany and Poland at
the end of World War 2.
Typhus Vaccine
One interesting fact which Pfannenstiel discussed in the
text quoted earlier was that in 1944, the Germans still did not have a
totally effective anti-typhus vaccine but only a vaccine which "protected
against death from the typhus"--in other words, they only had a vaccine
which reduced the severity of typhus when a vaccinated person contracted the
disease. American troops were repeatedly inoculated against typhus which
suggests that the American vaccine was not totally effective either. The
major line of defense against typhus, for the Americans as well as for the
Germans, was thorough and repeated delousing.
The SS personnel records for Dr. Josef Mengele show that
he contracted typhus while at Auschwitz even though he, as a doctor, would
certainly have been given preferred access to any available vaccine. There
were probably some bad experiences with the German anti-typhus vaccine which
is illustrated by the fact that even after the war at Belsen where a German
Army medical team had been put to work caring for the sick at the "human
laundry," at least one German doctor had refused to let himself be
vaccinated by the British against typhus and had apparently told the German
nurses not to take the vaccine either. About a month later, 32 of the 48
German nurses were in bed with typhus.22
The German wartime medical literature abounds with
articles about German research into the development of anti-typhus vaccines
and treatment. No doubt, there were many experiments upon concentration
inmates in this regard which did provide a basis for some atrocity stories
after the war. The principal beneficiaries of this research, however, were
the inmates themselves since it was they who were in the greatest danger
from typhus.
Typhus and the Jews
The German wartime medical literature makes it quite clear
that many Germans in positions of authority regarded the Jews as a major
source of typhus infestation in Poland. The articles by Zimmermann and
Ruppert (Appendices C & D) are typical of material that can be found in the
German literature. Of course, because these articles are highly critical of
Jews as a group and were written by Germans living under National Socialism,
many readers will simply dismiss them as anti-Semitic propaganda. The charge
of racial bias certainly comes to mind when one reads Ruppert's colorful
descriptions of Polish Jews, their primitive personal habits and their
abhorrence of simple hygiene. The Zimmermann article is, however, much more
difficult to dismiss in this manner. In any event, regardless of the
motivations of the two German authors, confirmation of many of their
observations can be found in credible non-Germans sources.
In a lengthy article published by the Royal Society of
Medicine, E. W. Goodall, one of Britain's most highly regarded
epidemiologists, described his experiences in Poland in the Summer of
1919:23
The city of Warsaw had at the time of the epidemic a
population of about 700,000 persons. I understood that this figure did not
include any of the German troops, but represented the civil, Polish,
population only. The epidemic started in the Jewish quarter of the city,
and at first spread chiefly amongst the Jews. According to Dr. Trenkner
the same thing happened at Lodz, of which city he was medical officer
before he was appointed to Warsaw in 1917, and in many other places in
Poland. Dr. Janiszewski confirms this statement. In the Warsaw epidemic,
73 per cent. of the cases occurred amongst the Jews, and 23 per cent. of
these in one particular part of the Jewish quarter where the population
was most dense. In the other quarters the number of cases was in
proportion to the number of Jews amongst the inhabitants. The Jews form 30
per cent. of the population of Warsaw. Roughly, the number of cases in the
different districts was in proportion to the density of population, and
the density is highest in the parts of the city inhabited by Jews.
Since the epidemic of 1917-18 typhus has become more
widely diffused through Warsaw, but the 1919 epidemic, if it can be called
such, was comparatively slight. Lately (1919) the Christians have been
attacked in larger numbers than the Jews. The attack-rate of the 1917-18
epidemic was between 3 per cent. and 4 per cent., and the fatality was
about 9 per cent. It is a curious fact that the fatality amongst the Jews
was half that of the Christians, 7 per cent. as against 14 per cent. Dr.
Trenkner accounted for this difference by the greater care and attention
the Jews bestowed upon their sick. They also called in medical advice
earlier than did the Christians, so that their patients came under
treatment sooner
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