History of Medicine

 

 TYPHUS AND REVOLUTION IN RUSSIA

         Russia and eastern Europe provided the setting of the largest outbreak of typhus ever recorded. Typhus had been a problem in Russia for centuries. The cold winter climate and a relative lack of bathing and personal hygiene were ideal for louse reproduction. A famine year, 1892, saw the largest outbreak of the disease before WWI, with 184,162 cases registered. The role of lice, under suspicion for some years, became clear only in 1909 when Charles Nicolle, working in Tunis, demonstrated louse transmission  of the disease, for which he received the Nobel Prize. The tiny, causative Rickettsia remained invisible. 

Charles Nicolle (Wikipedia)

         Medicine in the pre-revolutionary Russia, though lacking the organization and sophistication seen in Europe, was improving. Following the emancipation of the serfs in 1861, the government created “zemstvos,” self-governing units throughout the countryside whereby peasants had reasonable control over their own affairs. Hired “feldshers,” the rough equivalent of physician assistants, provided most of the rural medical care. The wretched living conditions faced by the zemstvos crystallized the need for a public health approach to disease control and a growing number of well-educated, liberal-minded physicians fostered this approach. World War One and the Bolshevik revolution,  however, changed everything.

Early in the war, typhus broke out among Russian soldiers imprisoned in a large camp near Cottbus, Germany. Two researchers assigned to the camp, Stanislaus von Prowazek, a brilliant Czech

Stanislaus von Prowazek (Wikipedia)

zoologist already known for his discovery of the agent of trachoma, and Henrique da Rocha Lima, a Brazilian physician working at the Bernard Nocht Institute in Hamburg, discovered that the typhus germ entered the body when louse feces were scratched into abraded skin, not during a bite. Tragically, both men contracted typhus, von Prowazek dying from it and da Rocha Lima surviving. Da Rocha Lima also found the offending organism under the microscope and named it Rickettsia prowazeki in honor of Howard Ricketts (who had succumbed to

Bust of da Rocha Lima (Wikipedia)

typhus while studying it in Mexico) and his deceased colleague at Cottbus. 

Typhus exploded in war-torn Serbia in 1915. The American Red Cross sent a commission, headed by Richard Strong from Harvard, to help. Strong was stunned by sights of extreme poverty, hospitals filled to over 400% of their capacity with louse-covered sufferers, virtually absent sanitary facilities, and crippled medical help (126 doctors had already died). The team constructed large steam generators, often using locomotives, and ovens of various types to sterilize clothing while the wearers of the clothing went into showers rigged in railroad cars or were doused with kerosene or benzene. These louse-killing measures, along with appropriate isolation practices, stemmed the epidemic, though only after about 150,000 deaths claimed by the disease.

Illustrations from Strong, et al, in Serbia

In Russia, the worst came a little later. Cases were apparent during the war, but real acceleration began in 1918, when Petrograd reported almost 11,000 cases and Moscow close to 7,000. Masses of troops were returning to their homes, either as deserters or released after the 1918 peace treaty of Brest-Litovsk, bringing lice and disease with them. The demilitarized soldiers who clogged the railroads, a subsequent civil war, a new and disorganized Bolshevik government, financial collapse, and subsequent famines, all created the conditions for a massive epidemic. Large numbers of city dwellers, escaping food and fuel shortages, moved to the countryside, spreading the germs further. The final tally is unknown but estimates of the total number of typhus cases run between 15 and 35 million (1918-22), involving the entire country from the Baltic to the Pacific. As an added calamity, scurvy, typhoid, tuberculosis, dysentery, cholera, and other diseases of social and economic collapse battered the population, along with a huge influenza epidemic.

Family living in boxcar, man lost legs to frostbite (Library of Congress)

Russian doctors, now down-graded as “bourgeois” in the new regime, knew the principles of control of typhus. Even Lenin knew, evidenced by his cry to attendees of the 1919 Party Congress, “All attention to this problem, comrades. Either lice will conquer socialism or socialism will conquer lice.” In fact, in the ensuing civil war, typhus was killing or incapacitating significant numbers of both the Red Army and the White Army as they battled it out for the future of Russia. Lenin’s government centralized medical services under the new “People’s Commissariat for Health Protection,” or NKZ, and provided crucial money for epidemic control. Gradually, as the Red Army prevailed, delousing activities similar to those employed in Serbia escalated and eventually gained the upper hand. Railroad stations and other public places, even railroad cars, where large numbers had gathered to escape the bitter cold, were especially targeted for delousing. Famines continued to plague the country and slow the efforts, but by 1923 typhus was under reasonable control. 

The American Red Cross played a role. Its mission to Siberia began in February 1919 as the “Inter-Allied Typhus Train,” partly as an anti-Bolshevik maneuver by the wartime allies and partly as a

American Red Cross Nurses, Russia (Wikipedia)

humanitarian effort. Departing from Vladivostok, the Train carried disinfection and delousing steam equipment, adopted from the Serbian experience, across a vast area. Along with their own medical personnel, the team hired Russian feldshers and other health workers and provided extensive educational materials about typhus transmission (sometimes resented by local doctors). In just over a year the Train covered 11,00 miles and treated over one million White Army soldiers and local civilians. The advancing Red Army made it dangerous to continue, however, and it terminated in May 1920.

Typhus had cemented its reputation as a disease of war, poverty, and famine. By World War II, in contrast, the advent of the insecticide DDT and awareness of the danger of lice served to prevent a massive recurrence of the scourge. It is now an uncommon disease and hopefully will remain so.

A full index of past essays is available at: https://museumofmedicalhistory.org/j-gordon-frierson%2C-md

 

SOURCES:

 

Patterson, K D, “Typhus and its Control in Russia, 1870-1940.” Medical History 1993; 37: 361-81.

 

Nachtigal, R, “Russian Public Health during the First World War.” J of Slavic Military Studies 2023; 36 (1): 73-95.

 

Sackmann, W, “Fleckfieber und Fleckfieberforschung zur Zeit des Ersten Weltkrieges.” Zeitschrift für Klinische Medizin 1924; 100(1): 203-22.

 

Irwin, J F, “The Great White train: typhus, sanitation, and U.S. International Development during the Russian Civil War.” Endeavor 2012; 30 (10): 1-9.

 

Jaenicke, L, “Stanislaus von Prowazek (1875-1915) – Prodigy between Working Bench and Coffee House.” Protist 2001; 152: 157-66.

 

Field, Mark G, Soviet Socialized Medicine: An Introduction. 1967, The Free Press, N.Y.

 

Strong, R P, et al, Typhus Fever with Particular Reference to the Serbian Epidemic. 1920, American Red Cross at Harvard Press, Cambridge, Mass.